The Use of Seclusion: A Comparison of Two Psychiatric Intensive Care Units

Abstract

The use of seclusion within a psychiatric intensive care unit in a South Australian metropolitan mental hospital was documented over a ten week period. The seclusion rate within the unit was 32% of all admissions and 34% of new admissions. The overall seclusion rate for the hospital was 5.4% of all admissions and 6.3% of new admissions, somewhat higher than in the United Kingdom but considerably lower than in the Eastern United States. A comparison was then made between consecutive new admissions (30 secluded and 30 non-secluded) to this unit and to a similar unit without a seclusion room in the other mental hospital in the State. Although seclusion offered no clear advantages in terms of duration of admission, levels of medication or relapse rates, it appeared to reduce the level of dangerousness in the unit, thereby enhancing staff morale. The overall mean daily total of neuroleptic medication was about 1,200 mg chlorpromazine equivalent, somewhat less than in comparable units in the United States and Europe.

Psychiatric Intensive Care Units: a Literature Review

“…First descriptions of PICUs started to appear in the 1970s in the UK (Mounsey 1979;Weaver, Broome, & Kat 1978), USA (Rachlin 1973) and in the 1980s in Australia (Goldney et al 1985;Goldney, Spence, & Bowes 1986;Hafner et al 1989;Jeffery & Goldney 1982) and Canada (Musisi, Wasylenki, & Rapp 1989).…”

“…A number of studies report or mention other types of containment used while patients are in PICU care: medication (coerced or rapid tranquillisation or PRN, see Table 1) ; seclusion (Brown & Bass 2004;Cohen & Khan 1990;Ford & Whiffin 1991;Hafner, Lammersma, Ferris, & Cameron 1989;Khan, Cohen, Chiles, Stowell, Hyde, & Robbins 1987;Michalon & Richman 1990;O'Brien & Cole 2004;Wynaden et al 2001); special observation (Citrome, Green, & Fost 1994;Hyde & Harrower-Wilson 1996); mechanical restraint (Cohen & Khan 1990;Khan, Cohen, Chiles, Stowell, Hyde, & Robbins 1987;Michalon & Richman 1990). The general impression conveyed is that such measures are used more frequently within a PICU environment than on general acute wards, and this impression is confirmed by the one study offering comparative information (Brown & Bass 2004), showing greater use of rapid tranquillisation and seclusion.…”

The effect of timeout duration on frequency of aggression in hospitalized children with conduct disorders

“…The trend in both published treatment studies and research directed toward addressing the duration issue specifically, has been that 'more is better' (see Benjamin et al, 1983, Foxx et al, 1980, and Glynn, Bowen, Marshall, & Banzett, 1989. Longer durations have been viewed as more punitive and, therefore, more effective (Garrison et al, 1989;Hafner et al, 1989;Kalogiera et al, 1989). Within the range of timeout durations studied, the present study does not support this finding.…”

“…A wide-range of timeout durations between these extremes have been cited in the literature (Angold, 1989;Carpenter, Hannon, McCleery, & Wanderling, 1988a, 1988bHafner, Lammersma, Ferris, & Cameron, 1989;Kalogjera, Bedi, Watson, & Meyer, 1989;Wong, Woolsey, Innocent, & Liberman, 1988). Attempts have been made to determine the role of duration in timeout effectiveness and to establish guidelines for selecting most effective timeout durations, generally producing inconclusive results (Benjamin, Mazzarins, & Kupfersmid, 1983;White, Nielsen, &Johnson, 1971).…”

Characteristics and outcomes of patients admitted to a psychiatric intensive care unit in a medium secure unit

“…Admission and discharge criteria are usually clearly defined and the majority have locked doors (Michalon & Richman, 1990;Hyde & Harrower-Wilson, 1996). The average length of stay ranges from 2.6 days (Hafner et al, 1989) to 30 days (Citrome et al, 1994), although Rachlin (1973) reported that 20% of his patients stayed over 2 months.…”