Use of Seclusion in a Psychiatric Acute Inpatient Unit

Abstract

Seclusion remains an important part of psychiatric practice. As expected, the use of seclusion in an adult acute unit reflected indirect measures of illness severity. Its use needs to be carefully reviewed and monitored, representing as it does the greatest restriction on a person's freedom.

Use of Coercive Physical Measures in a Psychiatric Ward of a General Hospital in Greece

“…Studies from psychiatric hospitals in the USA (Swett, 1994) have reported a seclusion rate of 12.7%, while in Australia and New Zealand higher rates have been observed, with 20% and 16% respectively of affected patients in acute psychiatric units (El-Badri & Mellsop, 2002;Tunde-Ayinmode & Little, 2004). Regarding European countries, a study by Kaltiala-Heino et al (2000) in general hospital psychiatric units in Finland reported a lower rate of seclusion: 6.6%.…”

“…This fi nding is not supported by Fisher (1994), who suggested that several diagnoses are associated with higher seclusion and restraint rates. Among diagnoses, schizophrenia (Thompson, 1986;El-Badri & Mellsop, 2002;Tunde-Ayinmode et al, 2004;Odawara et al, 2005), bipolar disorder (Thompson, 1986;El-Badri & Mellsop, 2002), organic and substance use-related disorders (Kaltiala-Heino et al, 2000;El-Badri & Mellsop, 2002;Odawara et al, 2005), personality disorders (Tardiff, 1981;Swett, 1994;Salib et al, 1998), and mental retardation (Tardiff, 1981;Thompson, 1986) are the most cited. The reason for the difference in the present study is not known.…”

“…However, attaining the lowest possible rate should be the objective of all inpatient units. Overuse of coercive physical measures is considered contrary to an adequate standard of care and may be an indication of an institutional failure to provide appropriate quality of psychiatric inpatient treatment (Tunde-Ayinmode & Little, 2004).…”

Use of mechanical and pharmacological restraint over an eight-year period and its relation to clinical factors

“…Reports on the effect of gender vary. Some studies report male gender to be a risk factor [20,22], others report a higher risk for female patients [19], and others find no effect of gender [20,24,25]. The time of day (peak in afternoon and early evening) and season (peak in autumn) are non-patient factors influencing the use of restraint [22].…”

Is the seclusion policy of mental health care users a necessary evil?

“…This is consistent with findings in the Australian study and that found in the review by Fischer in 1994, who found that the diagnoses associated with higher seclusion rates were psychosis, manic symptoms, character disorders, mental retardation and abnormal EEGs. [7,13] When correlating the reasons for seclusion with diagnosis, CI seemed to be a factor in users being secluded for their own safety as evidenced by schizophrenia, CI and dementia being the most common diagnoses. This is possibly due to the nature of their disability as they are vulnerable and open to abuse by other users in the ward.…”