Trajectories of seclusion and restraint use at a state psychiatric hospital

This study investigated patterns of seclusion and restraint among patients hospitalized at a psychiatric facility with a large number of forensic psychiatric beds.

Seclusion and restraint records were examined for 622 patients who were admitted during a five-year period (September 2001 to September 2006) and had a stay of at least 60 days. Seclusion and restraint episodes were recorded as bimonthly counts over the first two years after the initial admission. Latent class analysis was used to investigate the hypothesis that discrete seclusion and restraint trajectories exist.

Indices of model fit strongly supported the existence of three highly discrete trajectories. The low-trajectory class (71%) consisted of individuals who averaged less than .15 seclusion or restraint incidents per month over the course of their hospitalizations. Patients in the medium-trajectory class (22%) averaged approximately two incidents per month during the first two months, and rates declined to an average of about one incident per month by the end of the study period. Patients in the high-trajectory class (7%) averaged six incidents per month during the first two months, followed by a gradual decline in rates, where they then averaged two to three incidents per month by the end of the study period. The three groups differed significantly with respect to a number of diagnostic and demographic characteristics. While hospitalized, patients in the high-trajectory class were almost 30 times more likely to be named as perpetrators in incident and injury reports and 75 times more likely to be physically abused than patients in the low-trajectory class.

These findings have implications for clinical and administrative decision makers with regard to assigning new admissions to appropriate security levels, targeting patients with specialized treatment interventions, and moving low-risk patients into less restrictive treatment environments.