Seclusion reduction in a forensic mental health setting

Accessible summary Seclusion has become a contentious practice and, internationally, initiatives have commenced to reduce or eliminate its use. In forensic mental health hospitals, there are unique challenges and opportunities for the management of inpatient aggression and reduction of seclusion. This paper presents a project that was undertaken at an Australian forensic mental health hospital to reduce seclusion. The frequency and duration of seclusion events were reduced but there was less reduction in the number of patients that were secluded. At this time, seclusion may be necessary for the general safety of the unit. Abstract Seclusion has become a contentious practice and initiatives have commenced to reduce or eliminate its use. This paper presents the initiatives that were introduced during a seclusion reduction project that was undertaken at an Australian forensic hospital. These initiatives are based on the six core strategies that have been successfully used in North America to reduce seclusion. However, there are challenges (patient characteristics, prisoner culture and ensuring safety) and opportunities (longer admissions, higher staff–patient ratio, staff confidence, sound risk assessment and management) that can influence projects to reduce seclusion in a forensic hospital. During this project, the frequency (mainly multiple seclusions of patients) and duration of seclusion events were reduced but there was less reduction in the number of patients that were secluded. It is possible that the strategies were successfully supported by the identified opportunities to reduce the frequency and duration of seclusion but the challenges were significantly powerful in the early period of admission to prompt the need for seclusion. Reducing seclusion in a forensic hospital is a complex undertaking as nurses must provide a safe environment while dealing with volatile patients and may have little alternative at present but to use seclusion after exhausting other interventions.