Retrospective analysis of an intervention to reduce the use of seclusion

Abstract

Introduction: Seclusion reduction in the contemporary mental health services have become a priority around the world and in New Zealand. Various complex set of interventions are being recommended in the literature to successfully reduce seclusion especially after highly publicised successful reduction and elimination of seclusion in the Pennsylvania (USA) state hospitals. The intervention involving the change in structure of the unit/environment to provide more space for safe assessment of service users is not widely researched in forensic settings. Objective: The purpose of this study was to analyse the impact of a change in structure of the high care area (by creating an extra high care lounge) to reduce seclusion rates on the unit. Design: Retrospective pre and post study design. Setting: Acute admissions and assessment unit (male only, medium security) of Mason Clinic (Auckland Regional Forensic Psychiatric Services) situated in Auckland, largest metropolitan city in New Zealand with a population of 1.5 million people. Participants and methods: The participants were 132 service users present on the unit and admitted to the unit during 2-year study period. The retrospective seclusion data including demographic, clinical, forensic and other data were collected (pre-intervention group) from 18th January 2009 - 17th January 2010 and compared with (post-intervention group) from 18th January 2010 - 17th January 2011. Results: The intervention resulted in statistically significant reduction in the use of seclusion and seclusion duration in the post-intervention period. A substantial decrease in the seclusion events, secluded service users, and number of seclusion episodes also occurred. This reduction was achieved without an increase in use of other coercive measures or an increase in the assaults. However, this intervention required increased staffing levels. Conclusion: Seclusion reduction is possible in acute forensic settings despite challenging group of service users, without an increase in the use of other coercive measures and adverse outcomes. However, there are on-going cost implications for extra staffing levels. The reasons for the use of seclusion requires close monitoring to align with MOH seclusion guidelines. Further reduction of seclusion in forensic settings will be challenging and will require use of safer alternative interventions, changes in staff attitudes and should involve specific skills tailored for forensic nurses.