Innovation and pragmatism required to reduce seclusion practices

Area of Science:

• Forensic Psychiatry
• Mental Health Services Research
• Patient Safety

Background:

• Seclusion in psychiatric facilities poses risks to patients and staff, impacting therapeutic relationships and safety.
• Reducing seclusion is a priority for improving cost-effectiveness in psychiatric care.
• Developing effective alternatives to seclusion is challenging, with limited randomized controlled trial (RCT) evidence.

Purpose of the Study:

• To assess a novel intervention strategy for reducing long-term segregation in a high-security forensic psychiatry ward.
• To evaluate the impact of a pilot program combining stratified seclusion levels, multidisciplinary feedback, and occupational therapy.

Main Methods:

• Implementation of a pilot program on a high-security, high-dependency forensic psychiatry ward.
• Introduction of stratified levels of seclusion (long-term segregation).
• Integration of multidisciplinary feedback, information sharing, and a bespoke occupational therapy program.

Main Results:

• Demonstrated a reduction in seclusion rates.
• Received mainly positive staff feedback, noting increased ward dynamism and empowerment.
• Indicated potential for a more effective model of seclusion reduction in secure settings.

Conclusions:

• A structured, stratified approach to seclusion, with multidisciplinary input and tailored occupational therapy, may effectively reduce seclusion in high-secure hospitals.
• Innovative, pragmatic strategies, even without RCT-level evidence, can significantly impact clinical practice and guide future research in seclusion reduction.