Use of seclusion in a general hospital acute psychiatric unit

To examine the frequency of use of seclusion and the factors associated with its use in Lakeview Unit, a 29-bedded acute psychiatric unit in Naas General Hospital.

A survey was carried out involving a retrospective chart review of all patients secluded over a 12-month period, as well as a review of the seclusion register for this period. Secluded and non-secluded patients were compared for gender, nationality, age, diagnosis, duration of admission and admission status by reviewing discharge summaries of all patients admitted during the 12-month period.

Most (75%) of the secluded patients were secluded only once. Half of seclusion events were initiated in the first week of admission. Length of time spent in seclusion ranged from 50 minutes to 96 hours, with a mean duration of 25 hours 20 minutes. Seclusion was most often associated with risk to others and risk to self. Alternatives to seclusion considered included verbal de-escalation, medication, special nursing, single room accommodation and time out Male and non-Irish patients were more likely to be secluded. There was no significant difference between secluded and non-secluded patients in terms of age. Patients with psychotic disorders tended to be secluded more frequently than others, followed by patients with bipolar affective disorder and substance use disorders. Longer duration of admission and involuntary admission status were strongly associated with seclusion.

Seclusion remains an important part of psychiatric practice on Lakeview Unit, and reflects indirect measures of illness severity. In order to reduce the duration of seclusion episodes, the development of alternative containment strategies needs to be addressed. Seclusion audits should be carried out regularly to ensure that best practice is adhered to.