Alternatives to seclusion in psychiatric care

The use of seclusion in psychiatry is declining. Its punitive nature has been acknowledged and alternative, more therapeutic approaches are needed to deal with disturbed patients. What alternatives are available? This article reports a study that sought to examine the response to incidents that formerly would have led to seclusion in one psychiatric intensive care unit. The sample consisted of 50 incidents. Information on the incident and subsequent action was recorded on standard incident forms and specially designed data collection sheets. The most frequent type of incident was damage to property, followed by direct or threatened physical assault on staff. The most common response was one-to-one nursing support, followed by the use of medication. In just over half the incidents, both responses were used together. This therapeutic strategy demonstrates that aggressive incidents can be dealt with safely without recourse to seclusion.