Factors associated with seclusion in a statewide forensic psychiatric service in Australia over a 2‐year period

Abstract

Despite seclusion being described as one of the most ethically- and legally-controversial management options available, it remains a widely-used clinical strategy for managing disruptive, aggressive, and violent behaviour. This study sought to determine how frequently seclusion was used, the common characteristics of those secluded and not secluded, and the degree to which the Level of Service Inventory - Revised: Screening Version (LSI-R: SV) could predict seclusion. The study was retrospective, covering the first 2 years of operation of a statewide forensic psychiatry hospital in Victoria, Australia. Data were collected from individual case files, electronic databases, and paper copies of records pertaining to violent incidents and episodes of seclusion. Eighty five (44%) of the 193 patients admitted during this period were secluded. Those secluded were significantly younger and had a more established psychiatric history. LSI-R: SV scores were significantly and positively associated with being secluded. A statistical model containing three LSI-R: SV items, along with age on admission and psychiatric history, achieved an area under the curve of 0.74. Seclusion is used on a regular basis in response to a range of different forms of aggressive behaviour of different severity. The LSI-R: SV demonstrated moderate-to-good accuracy in predicting seclusion and warrants further research using detailed prospective methodologies.

Seclusion and restraint use in adult inpatient mental health care: An Australian perspective

“…The rates in forensic units were much lower than those of the two separate HDUs and the general units with a co-located HDU. A twoyear retrospective study of an Australian forensic mental health service found 44% of patients admitted during this period were secluded (Thomas et al, 2009). The relatively low rates in our study could be the result of the inclusion of three rehabilitation wards where patients are often prepared to be transferred to a nonforensic ward or the community.…”

Scratching Beneath the Surface: Influencing Factors on Nurses’ Attitudes Toward the Use of Seclusion

“…Although research has examined the attitudes of nurses towards the practice of seclusion (Alty, 1997;Bonner et al, 2002;Duxbury, 2002;Larue et al, 2007;Lee et al, 2003;Lewis, Taylor, & Parks, 2009;Meehan et al, 2004;Moran et al, 2004;Terpstra et al,. 2001; Thomas et al, 2009;Wynaden et al, 2001), interestingly little attention has focused on what factors might underpin or influence these attitudes.…”

Police management of mental health crisis situations in the community: status quo, current gaps and future directions

“…Markowitz 2011), leading to changes in the profile of the patient group receiving inpatient care and treatment. With the shift of patient profiles it is perhaps not surprising that violent incidents have increased within public psychiatric hospitals and become a commonplace recurring challenge for staff, especially those at the frontline of psychiatric care provision (Gudjonsson et al 1999, Thomas et al 2009). Indeed, research from the United States of America, United Kingdom, Australia and Canada reports that workplace violence in the healthcare sector has significantly increased over the last decade (RCN 1999, Rippon 2000, Stirling et al 2001, Carter 2002.…”