Exploring Patterns of Seclusion Use in Australian Mental Health Services

https://doi.org/10.1016/j.apnu.2011.04.001Get rights and content

Seclusion has remained a common practice in mental health services. In Australia, recent mental health policy has reflected a desire to reduce (and, if possible, eliminate) the use of seclusion. The collection and analysis of data on the use of seclusion have been identified as an important component of the success of reduction initiatives. A cross-sectional design was used in the collection of inpatient unit data on seclusions that occurred in 11 mental health services in Australia over a 6-month period. During this time, there were 4,337 episodes of care. One or more seclusions occurred in 6.8% of episodes of care, with consumers being secluded, on average, 2.32 times and with 44% of them having been secluded more than once. The average length of the seclusions was 2 hours 52 minutes, with 51.4% of seclusions being less than 2 hours. These rates were lower than those reported in previous research studies. The practice of seclusion occurred more commonly on the first 2 days following admission, on weekdays than weekends, and between the hours of 9:00 a.m. and midnight. An understanding of seclusion data can provide fundamental information from which strategies to reduce seclusion can be developed.

Section snippets

Design

A cross-sectional design was used with data collected in mental health inpatient units from 11 mental health services in Australia.

Setting

Eleven mental health services were involved in this project, including at least one service from each of the states and territories in Australia. These services were part of a Commonwealth Government-funded project to reduce the use of seclusion. Data were collected with the aim of gaining knowledge about circumstances and factors associated with the use of

Results

Seclusions occurred during 295 of the 4,337 episodes of care (6.8%). During the 295 episodes of care when seclusions occurred, there were 683 seclusions. Of those patients who had been secluded, the mean number of episodes of seclusion was 2.32 (SD = 2.28) per patient. The data on the number of seclusions each patient had experienced were positively skewed, with 55.9% of patients being secluded on only 1 occasion. Most patients (95.3%) had been secluded on 6 or fewer occasions. Two patients,

Discussion

The rates of seclusion demonstrated in this research are lower than the official Australian statistics (Roberts et al., 2009). They are also considerably lower than those identified in other Australian research (Department of Human Services, 2005, Roberts et al., 2009, Tunde-Ayinmode and Little, 2004) and, in fact, lower than the rates quoted in most of the international research (El-Badri and Mellsop, 2002, Korkeila et al., 2002, LeGris et al., 1999, Mental Health, 2004, Morrison and Lehane,

Conclusions

This study was conducted across 11 mental health services throughout all of the states and territories of Australia. These services were part of a national project with the primary intention of reducing the use of seclusion. The findings were lower than the national average for frequency of seclusion, length of seclusion, and percentage of consumers secluded more than once. The pattern of use of seclusion in terms of day following admission, time of day, and day of the week was similar to the

Acknowledgment

The authors express their thanks to the project team for the opportunity to be involved in the analysis of these important data. Sincere thanks also to the project teams at each of the 11 mental health services.

References (60)

  • J. Colaizzi

    Seclusion and restraint: A historical perspective

    Journal of Psychosocial Nursing and Mental Health Services

    (2005)
  • Commonwealth of Australia

    National safety priorities in mental health—A national plan for reducing harm

    (2005)
  • W.B. Crenshaw et al.

    A national survey on seclusion and restraint in state psychiatric hospitals

    Psychiatric Services

    (1995)
  • Department of Human Services

    Annual Report 2003: Office of the Chief Psychiatrist. Retrieved October 27, 2005, from Office of the Chief Psychiatrist, Victorian Department of Human Services Web site

    (2004)
  • Department of Human Services

    Seclusion: Chief Psychiatrist's Guideline. Retrieved 27 October, 2005, from Chief Psychiatrist's Guidelines, Victorian Department of Human Services Website

    (2005)
  • D.C. Donat

    An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital

    Psychiatric Services

    (2003)
  • J. Duxbury

    An evaluation of staff and patient views of and strategies employed to manage inpatient aggression and violence on one mental health unit: A pluralistic design

    Journal of Psychiatric and Mental Health Nursing

    (2002)
  • S.M. El-Badri et al.

    A study of the use of seclusion in an acute psychiatric service

    Australian and New Zealand Journal of Psychiatry

    (2002)
  • W.A. Fisher

    Restraint and seclusion: A review of the literature

    American Journal of Psychiatry

    (1994)
  • W.A. Fisher

    Elements of successful restraint and seclusion reduction programs and their application in a large, urban, state psychiatric hospital

    Journal of Psychiatric Practice

    (2003)
  • R. Flannery et al.

    Psychiatric patient assault and staff victim gender: Fifteen-year analysis of the assaulted staff action program

    Psychiatric Quarterly

    (2007)
  • C.I. Garcia et al.

    Coercive measures in a psychiatric inpatient unit

    Anales de Psiquiatria

    (2001)
  • C.J. Gaskin et al.

    Interventions for reducing the use of seclusion in psychiatric facilities: Review of the literature

    The British Journal of Psychiatry

    (2007)
  • V. Hamrin et al.

    A review of ecological factors affecting inpatient psychiatric unit violence: Implications for relational and unit cultural improvements

    Issues in Mental Health Nursing

    (2009)
  • B. Happell et al.

    Nurses' attitudes to the use of seclusion: A review of the literature

    International Journal of Mental Health Nursing

    (2010)
  • B. Happell et al.

    Attitudes to the use of seclusion: Has contemporary mental health policy made a difference?

    Journal of Clinical Nursing

    (2010)
  • B. Happell et al.

    From numbers to understanding: The impact of demographic factors on seclusion rates

    International Journal of Mental Health Nursing

    (2010)
  • K.A. Huckshorn

    Reducing seclusion & restraint use in mental health settings: Core strategies for prevention

    Journal of Psychosocial Nursing and Mental Health Services

    (2004)
  • J.A. Korkeila et al.

    Predicting use of coercive measures in Finland

    Nordic Journal of Psychiatry

    (2002)
  • C. Larue et al.

    Factors influencing decisions on seclusion and restraint

    Journal of Psychiatric & Mental Health Nursing

    (2009)
  • Cited by (20)

    • Nursing staff composition and its influence on seclusion in an adult forensic mental health inpatient setting: The truth about numbers

      2022, Archives of Psychiatric Nursing
      Citation Excerpt :

      What was not ascertained from the data was whether the lead nurse was present on the ward performing daily tasks, attended the ward in response to an incident that resulted in seclusion or whether the lead nurse attended the ward and instigated the seclusion intervention. Consistent with other research (Happell & Gaskin, 2011; Smith et al., 2015), this study found that seclusion events occurred most often on day and late shifts (supporting Hypothesis 1a). This could be attributed to a number of variables including higher clinical acuity on the wards during daylight hours; increased presence of interdisciplinary team members, administrative and operational burdens taking nurses away from direct patient care.

    • Seclusion in the Management of Highly Disturbed Children and Adolescents

      2016, Positive Mental Health, Fighting Stigma and Promoting Resiliency for Children and Adolescents
    View all citing articles on Scopus
    View full text