Use of seclusion in a psychiatric acute inpatient unit

To examine the rate and characteristics of seclusion among a group of patients admitted to an adult acute psychiatric unit as a precursor to planning an audit cycle and quality improvement project.

A retrospective chart review of all inpatient admissions to an adult acute unit over a 12 month period was undertaken with the use of a specially developed proforma. A comparison of secluded and non-secluded patients was described, and, where possible, statistically analysed.

Four hundred and fifty admissions occurred during the study period, resulting in 140 episodes of seclusion. This represented a seclusion rate of 31% per admission. In contrast to patients who were not secluded, those secluded were more likely to be young, admitted involuntarily and with a diagnosis of schizophrenia. The most common indicator of seclusion was risk to others (74%) followed by risk to self (61%) and risk of absconding (55%). Length of time in seclusion ranged from 1 to 49 h with a mean of 9 h. Thirty-nine per cent of secluded patients were secluded on two or more occasions. Interventions including counselling, time out and medication were used in 71% prior to seclusion; however, in 29% no intervention was documented. Seclusion was more likely to occur in the evenings, when staff/patient ratios were lower.

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.