A study of the use of seclusion in an acute psychiatric service

OBJECTIVE: In recent years, increased attention has been paid to significantly restrictive practices taking place in psychiatric services in New Zealand. The aim of this study was to prospectively examine the frequency of use of seclusion and the factors associated with its use in the acute general adult psychiatric wards serving the Waikato area. METHODS: Information on the use of seclusion and relevant demographic data were collected over a 9-month period in 2000. The patterns of locked seclusion use and the characteristics of patients who had been secluded were examined. Analysis compared patients requiring one or more episode of seclusion (n = 84) with those never secluded (n = 455). RESULTS: Of a total of 539 patients admitted to the general adult unit during our study period, 84 (16%) were secluded in 129 seclusion episodes. About two-thirds of the seclusion events were initiated in the first week of the patient's admission, and three-quarters of secluded patients had only one episode. The median duration of seclusion was 14 hours. Comparison of gender and race revealed significant differences between the groups. Diagnosis, but not age, had a significant effect on whether a patient would be secluded. Seclusion was mainly associated with risk of, or actual, violence toward staff, patients or property. CONCLUSIONS: This study shows that seclusion is regularly practiced in the psychiatric wards of the Waikato area. In the majority of cases, its use was related to actual or threatened violence. Male, non-European patients and patients with certain diagnoses were at particular risk for seclusion. More research is required to examine the most effective use of seclusion and also the development and use of alternative strategies in controlling aggressive behaviour.