Heavy-tailed distribution of seclusion and restraint episodes in a state psychiatric hospital

Regulations that govern oversight of seclusion and/or restraint episodes (SREs) in the United States are relatively uniform and may assume that such events are normally distributed within the population generating them. This study illustrates that the distribution of patients who required one or more SREs within one state psychiatric hospital setting is heavy-tailed-that is, a small group of patients generated a disproportionate majority of the events: 20 percent of patients with the most SREs accounted for approximately 75 percent of the total number of SREs; 10 percent of patients accounted for 61 percent, and 1 percent of patients accounted for 21 percent. Characteristic features of heavy-tailed distributions are described and discussed in relation to the feasibility of eliminating SREs in mental health settings and the governance of SREs by uniform regulations. Attempts are made to model and subtype the distribution, and commentary is made as to potential clinical and policy relevance of the findings.