A clinical improvement project to develop and implement a decision-making framework for the use of seclusion

The use of seclusion within acute psychiatric settings is contentious. As evidenced by its use in practice, seclusion continues to be supported by mental health-care professionals. However, there is a growing evidence base that indicates that it is viewed negatively by patients and causes symptoms of severe distress. In Australia and several other countries, the use of restraint and seclusion is now being questioned, and there are now policy directives to reduce or abandon these practices. Despite mental health-care professionals' awareness of the potential detrimental effects of seclusion, the practice is strongly embedded in Australian mental health settings. This paper describes an improvement project to develop and implement a clinical decision-making framework around the use of seclusion. The setting was an acute mental health-care facility servicing a large health district in south east Queensland, Australia. The impetus for this project was driven by concerns expressed by consumers of the service and our own need to reduce the incidence of seclusion and the length of time of seclusion events to below 4 hours' duration. This improvement project employed practice development and action research principles to engage colleagues in the development of the framework. The project duration was 6 months, and resulted in two decision-making frameworks around the use of seclusion: the decision to seclude and the decision to release.