Seclusion as a coercive measure in suicidality - daily routine or exception?

Area of Science:

• Psychiatry
• Clinical Psychology
• Hospital Administration

Background:

• Coercive measures in psychiatry lack proven effectiveness, particularly for suicidal patients.
• There is a long-standing effort to replace coercive interventions with non-coercive alternatives.
• This study examines seclusion practices for suicidal patients in a Swiss psychiatric hospital.

Purpose of the Study:

• To clarify the use of seclusion for suicidal patients in a general psychiatric hospital.
• To investigate whether alternative, non-coercive measures were offered to patients secluded solely for suicidality.

Main Methods:

• Retrospective cohort study using routinely collected medical data.
• Qualitative analysis of medical histories for patients aged 18-65.
• Inclusion of inpatient treatment cases from September 2016 to December 2019.

Main Results:

• Suicidality occurred in 3.7% of 5,935 inpatient cases.
• Coercive seclusion exclusively for suicidality occurred in 33.3% of relevant cases (53/159).
• Non-secluded patients received alternative interventions more frequently; seclusion rates varied by ward and were higher for non-Swiss patients or those with language barriers.

Conclusions:

• A general attitude to avoid coercive measures is crucial to prevent seclusion for suicidal patients.
• Staff training to manage challenging sociodemographic factors, including language barriers, is essential.
• Utilizing translators and intercultural interpreters can aid in managing diverse patient populations.