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

Abstract

Background. Seclusion in the psychiatric context is the involuntary confinement of an agitated, unstable person alone in a contained, controlled environment. Differing views on seclusion presents clinicians with an ethical dilemma. Significant morbidity and mortality have been associated with seclusion. No data exist in South Africa on rates of seclusion for psychiatric purposes. Consequently neither the need for seclusion 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 the reasons for seclusion.

Methods. A retrospective record review of patients secluded at Sterkfontein Hospital, over a six-month period.

Results. A total of 112 patients were secluded over the six-month period. Users were secluded for a total of 59 415.5 hours and on 4 814 separate 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 were secluded for aggression (either physical or verbal). The most common diagnosis was schizophrenia (31.4%) followed by cognitive impairment (20.6%) and bipolar mood disorder (13.7%). The most commonly used medication was sodium valproate (17%), followed by haloperidol (11%) and risperidone (11%).

Conclusion. Younger male patients with psychosis were most likely to be secluded. More research should be conducted locally to compare seclusion rates and patient profiles so that we may improve seclusion practices.