Abstracts

Abstract

In the literature on seclusion, the incidence and duration of seclusion have been studied with relation to particular characteristics of the individual patient (age, gender, country of birth, length of stay and diagnosis), and results have frequently been contradictory. Other studies have examined the seclusion practices of a selected service or group of services, finding that external factors such as temporal variables, the nature and staffing of a service, the physical environment and the ward culture may affect seclusion use. There has been a relative paucity of quantitative data in the literature to determine the roles of these variables. In Victoria, an extensive amount of data is held by the Office of the Chief Psychiatrist, as all episodes of seclusion are required by law to be reported to the Chief Psychiatrist. This study is a detailed analysis of all reported seclusion episodes in Victorian adult services over the course of the year 1999-2000, critically examining patterns of seclusion use and identifying service-based, patient-based and temporal influences on seclusion. Overall, 13.1% of all admissions into public mental health services for the year included a seclusion episode at some stage, and the mean duration of a seclusion episode was 4.8 hours. These results reflect relatively more frequent seclusion episodes than in the UK but less frequent episodes than in the US, and seclusion episodes lasting for shorter time periods than reported in studies from either the US or the UK. The overall rate of seclusion varied significantly across the year and across the week, and the majority (82.4%) of seclusion episodes occurred in the first half of the admission. Seclusion was significantly both less frequent but more prolonged in rural centres, and significantly more common and prolonged in centres without a high-dependency unit. Secluded patients had significantly longer admissions than non-secluded patients, and convincing results were obtained linking an increase in seclusion incidence and duration with male gender, younger age and psychosis. Several diagnostic categories were negatively associated with the incidence of seclusion, in particular the diagnoses of major affective disorder, acute stress reaction, and anxiety disorder, and having no identifiable psychiatric diagnosis. There is wide scope for further investigation of associations with seclusion. Accurate data on the reasons for seclusion, temporal factors across the day for secluding or breaking seclusion, the composition of staff on the ward at the time of seclusion is required. Research is also needed into the efficacy of seclusion, and under what circumstances it may be best used.