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Seclusion reduction in a forensic mental health setting.

T Maguire¹, R Young, T Martin

¹Victorian Institute of Forensic Mental Health, Fairfield, Australia. tessa.maguire@forensicare.vic.gov.au

Journal of Psychiatric and Mental Health Nursing

|January 4, 2012

Summary

Seclusion reduction initiatives in an Australian forensic hospital decreased seclusion frequency and duration. However, challenges like patient characteristics and safety concerns limited reductions in the number of secluded patients.

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Area of Science:

Forensic Psychiatry
Mental Health Nursing
Patient Safety

Background:

Seclusion is a contentious practice in mental health care, prompting initiatives for its reduction or elimination.
This study focuses on a seclusion reduction project implemented in an Australian forensic hospital setting.

Purpose of the Study:

To present initiatives based on North American strategies for seclusion reduction.
To explore challenges and opportunities influencing seclusion reduction projects in forensic settings.

Main Methods:

Implementation of six core seclusion reduction strategies adapted from North American models.
Analysis of seclusion events, including frequency, duration, and number of patients secluded.
Consideration of influencing factors such as patient characteristics, hospital culture, and safety protocols.

Main Results:

A reduction in the frequency and duration of seclusion events was observed.
The number of individual patients subjected to seclusion showed less significant reduction.
Initiatives were supported by opportunities like higher staff-patient ratios and improved risk management.

Conclusions:

Reducing seclusion in forensic hospitals is complex, influenced by patient volatility and safety imperatives.
While frequency and duration decreased, challenges in early admission periods necessitate further strategies.
Nurses face difficulties in managing volatile patients safely without resorting to seclusion as a last resort.