title: Factors associated with seclusion in a statewide forensic psychiatric service in Australia over a 2-year period.
abstract: Despite seclusion being described as one of the most ethically- and legally-controversial management options available, it remains a widely-used clinical strategy for managing disruptive, aggressive, and violent behaviour. This study sought to determine how frequently seclusion was used, the common characteristics of those secluded and not secluded, and the degree to which the Level of Service Inventory - Revised: Screening Version (LSI-R: SV) could predict seclusion. The study was retrospective, covering the first 2 years of operation of a statewide forensic psychiatry hospital in Victoria, Australia. Data were collected from individual case files, electronic databases, and paper copies of records pertaining to violent incidents and episodes of seclusion. Eighty five (44%) of the 193 patients admitted during this period were secluded. Those secluded were significantly younger and had a more established psychiatric history. LSI-R: SV scores were significantly and positively associated with being secluded. A statistical model containing three LSI-R: SV items, along with age on admission and psychiatric history, achieved an area under the curve of 0.74. Seclusion is used on a regular basis in response to a range of different forms of aggressive behaviour of different severity. The LSI-R: SV demonstrated moderate-to-good accuracy in predicting seclusion and warrants further research using detailed prospective methodologies.
authors.affiliation: School of Psychiatry, Psychology and Psychological Medicine, Monash University, Victorian Institute of Forensic Mental Health, Melbourne, Victoria, Australia. stuart.thomas@med.monash.edu.au
authors.forename: Stuart D M
authors.initials: SD
authors.lastname: Thomas
authors.forename: Michael
authors.initials: M
authors.lastname: Daffern
authors.forename: Trish
authors.initials: T
authors.lastname: Martin
authors.forename: James R P
authors.initials: JR
authors.lastname: Ogloff
authors.forename: Lindsay D G
authors.initials: LD
authors.lastname: Thomson
authors.forename: Murray
authors.initials: M
authors.lastname: Ferguson
mesh_terms: D000328:Adult; D017677:Age Distribution; D003134:Commitment of Persons with Psychiatric Disorders; D005260:Female; D005555:Forensic Psychiatry / Q000458:organization & administration*; D006778:Hospitals, Psychiatric; D006801:Humans; D007297:Inpatients / Q000523:psychology / Q000706:statistics & numerical data*; D008297:Male; D015233:Models, Statistical; D009730:Nursing Assessment; D009731:Nursing Audit; D015403:Nursing Evaluation Research; D010356:Patient Isolation / Q000523:psychology / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D011568:Psychiatric Nursing / Q000458:organization & administration*; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D014739:Victoria; D014754:Violence / Q000517:prevention & control / Q000523:psychology / Q000706:statistics & numerical data; D055815:Young Adult