Evaluation of the effect of a structured intervention for the management of behavioural disturbance on the level of seclusion in an acute psychiatric inpatient ward

Abstract

Background: Seclusion in psychiatric inpatient settings is contentious, and services attempt to minimize its use. Many studies compare seclusion rates before and after the introduction of an intervention, but few control for the effect of external factors such as legislative constraints and patient characteristics.Aims: To evaluate the effect of a programme designed to manage acute arousal.Method: Seclusion rates in a six-month period incorporating a programme to manage acute arousal were compared with the previous six months. The intervention focused on formal assessment of arousal levels and an escalating set of actions by nursing staff.Results: Seclusion rates in the two periods were comparable, both before and after controlling for patient characteristics. Duration of seclusion events appeared to be heavily influenced by local legislative constraints.Conclusions: A programme designed to reduce seclusion showed no difference from baseline after taking various factors into account. This may have been at least partly because most seclusion events occurred early in an admission. Many patients arrive on the unit already requiring seclusion, and any impact of a ward programme on them is limited. Since seclusion is a comparatively uncommon event, and attributable to a minority of patients, appropriate analytic methods are required.