The distribution and frequency of seclusion and/or restraint among psychiatric inpatients

This paper reports on the frequency and distribution of seclusion or restraint (SR) episodes among 1,266 adult inpatients at a state psychiatric hospital during the 2004 calendar year. Data on the concentration of SR episodes over patients and time can assist in planning alternative, recovery-oriented treatment models. Fifteen percent (N = 194) of patients experienced seclusion or restraint. Sixty-three percent of all seclusion hours were concentrated among only ten patients. Likewise, the ten patients with the most restraint hours constituted nearly 65% of total restraint hours for the year and 48% of all restraint episodes. Variables accessible through administrative data accounted for modest seclusion and restraint variance. A comprehensive strategy to prevent SR episodes requires tailored interventions targeted to known high-risk individuals and development of general hospital-wide alternatives to SR. General alternatives require greater attention to staff education, administrative oversight, de-escalation and debriefing practices, patient involvement, and other recovery-oriented practices to reduce or eliminate use of seclusion and restraint.