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Seclusion: Patterns and Milieu

Patterns of locked seclusion use were reviewed on an inpatient service caring for both voluntary and involuntary patients. Hospital records of 313 sequentially admitted patients were studied, comparing those patients requiring one or more episode of seclusion with those never secluded. Eighteeen per cent of the patients studied were secluded, a group significantly younger, more likely to have a manic-like illness, more often never married, and more frequently involuntarily hospitalized than the nonsecluded group. Patterns of seclusion frequency, duration, and numbers of episodes per patient are discussed in the context of the milieu. The modal pattern of seclusion in our study was for it to occur in the first week of hospitalization, for there to be one or two episodes per patient, and for total seclusion time to be 3 hours or less. The authors conclude that early and judicious use of seclusion with both voluntary and involuntary patients is compatible with modern hospital work and that the pattern of use reflects both clinical and milieu parameters.