Practice of Seclusion: A Five-Year Retrospective Review in North Cheshire

Abstract

This study examines, retrospectively, the trends and factors associated with the use of seclusion over a five-year period in a regional secure unit located within a large psychiatric hospital that serves the population of North Cheshire. Ninety-four patients (15.3% of total admissions to the unit) spent some time in seclusion on 186 occasions. The average time spent in seclusion was 85 minutes (minimum 15 minutes and maximum 10 hours). Sixty-seven per cent of patients were secluded once, 20% secluded twice, and 13% more than three times. Patients with a clinical diagnosis of personality disorder (11.4%) accounted for 44.2% of seclusions whereas those with a defined mental disorder (55%) accounted for 35% of all seclusions. The rate of seclusion, characteristics of secluded patients, reasons, and average duration spent in seclusion, did not vary significantly over the study period, despite the significant reduction of the unit's admission rate from 150 to 63 per year. The consistent and regular occurrence of the practice over a five-year period may suggest that seclusion of some disturbed patients will inevitably continue to be used as an effective intervention and, probably at times, the only acceptable method that may ensure the safety of patients and staff.

Seclusion and the use of antipsychotics in hospitalized psychiatric patients

“…The overall prevalence of seclusion found in the current study was high compared with other European countries (Salib, Ahmed, & Cope, 1998;Kaltiala-Heino, Korkeila, Tuohimaki, Tuori, & Lehtinen, 2000). More than a quarter (i.e.…”

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“…This renders comparisons impossible. The data from other studies is related only to single units [17] (UK), [18] (Australia), [19] (USA) and can therefore not be compared with our data, either. Except for one study from Finland [6] there seems to be no comparable data.…”

Factors influencing seclusion rates in an adult psychiatric intensive care unit

“…In some studies, seclusion has been grouped together with other interventions such as restraint and administration of parenteral medication or it has not been made clear how it was measured (D'Orio et al, 2004;Donat, 2003;Donovan et al, 2003;Duxbury, 2002;El-Badri & Mellsop, 2002;Hafner et al, 1989;Haller et al, 1996;Kaltiala-Heino et al, 2003;Khadivi et al, 2004;O'Brien & Cole, 2004;Salib et al, 1998;Tunde-Ayinmode & Little, 2004;Visalli & McNasser, 2000). Previous studies have, for instance, measured number of episodes of seclusion in a given time period.…”