Is the seclusion policy of mental health care users a necessary evil?

Abstract

Background. Seclusion in the psychiatric context is the involuntaryconfinement of an agitated, unstable person alone in a contained,controlled environment. Differing views on seclusion presents clinicianswith an ethical dilemma. Significant morbidity and mortality have beenassociated with seclusion. No data exist in South Africa on rates ofseclusion for psychiatric purposes. Consequently neither the need forseclusion nor alternatives to seclusion have been explored.Objective. To determine the number of patients secluded over six months,provide a profile of patients that were secluded, and to ascertain thereasons for seclusion.Methods. A retrospective record review of patients secluded atSterkfontein Hospital, over a six-month period.Results. A total of 112 patients were secluded over the six-monthperiod. Users were secluded for a total of 59 415.5 hours and on 4 814separate occasions. A total of 84.8% of the users secluded were male.The mean age of users secluded was 29 years. Just under half the users(49.1%) were secluded for their own safety and 40% of users weresecluded for aggression (either physical or verbal). The most commondiagnosis was schizophrenia (31.4%) followed by cognitive impairment(20.6%) and bipolar mood disorder (13.7%). The most commonly usedmedication was sodium valproate (17%), followed by haloperidol (11%)and risperidone (11%).Conclusion. Younger male patients with psychosis were most likely to besecluded. More research should be conducted locally to compare seclusionrates and patient profiles so that we may improve seclusion practices.