On the seclusion of psychiatric patients

Abstract

The seclusion of psychiatric patients is viewed by some as a violation of basic human rights, by others as a necessity for the control of violence, and by still others as a therapeutic modality. The purpose of this paper is to synthesize the findings from the limited and descriptive research on this controversial practice. The major conclusions suggested by the findings are: (1) The reason cited for seclusion is more often agitation than violence, raising questions as to its necessity. The lack of relationship between the reason for seclusion and its duration indicates loose and arbitrary criteria and raises the question of bias. (2) The tendency to seclude on admission suggests failure to follow the legal stipulation that less restrictive measures be employed first. (3) Psychotic, involuntary and younger patients are at higher risk for seclusion than other patients. (4) Incidence and duration of seclusion differ widely across institutions indicating unnecessary and excessive use in some units. Differences may be better explained by hospital factors such as location, staff attitudes and treatment philosophy than by patient characteristics. (5) Systematic studies of the effectiveness of seclusion are lacking, as is research on events transpiring during seclusion. (6) Attitudes of patients and staff toward seclusion differ greatly. Patients' attitudes are generally negative, whereas staff members believe seclusion benefits patients and preserves the unit's smooth functioning. Changes in procedures are suggested to reduce the frequency of seclusion, and to make seclusion more rational, effective and humane. Research and clinical implications are discussed.