Frequency of seclusion in an adolescent psychiatric unit

The frequency and character of seclusion and restraint use on an adolescent psychiatric ward were analyzed by examining 369 written reports and comparing characteristics of low-frequency with high-frequency seclusion years. Contributors to high-frequency use of seclusion included lack of staff response to persistent limit testing, appeals to cognitive mechanisms and dynamic understanding at times of behavioral outbursts, staff conflicts, and unduly restrictive criteria for use of antipsychotic medications. Patients with borderline personality characteristics were allowed to act in increasingly disordered fashion without staff intervention before seclusion and restraint were used, and were likely to be secluded in disproportionately large numbers during outbreaks of violence. Changes in expectations and performance by staff lowered the number of seclusions by 66% during a period when the patient load increased.