title: The practice of seclusion and time-out on English acute psychiatric wards: the City-128 Study.
abstract: BACKGROUND
  Seclusion is widely used internationally to manage disturbed behavior by psychiatric patients, although many countries are seeking to reduce or eliminate this practice. Time-out has been little described and almost completely unstudied.
  
  
  OBJECTIVE
  To assess the relationship of seclusion and time-out to conflict behaviors, the use of containment methods, service environment, physical environment, patient routines, staff characteristics, and staff group variables. Data from a multivariate cross-sectional study of 136 acute psychiatric wards in England were used to conduct this analysis.
  
  
  RESULTS
  Seclusion is used infrequently on English acute psychiatric wards (0.05 incidents per day), whereas time-out use was more frequent (0.31 incidents per day). Usage of seclusion was strongly associated with the availability of a seclusion room. Seclusion was associated with aggression, alcohol use, absconding, and medication refusal, whereas time-out was associated with these and other more minor conflict behaviors. Both were associated with the giving of "as required" medication, coerced intramuscular medication, and manual restraint. Relationships with exit security for the ward were also found.
  
  
  CONCLUSIONS
  Given its low usage rate, the scope for seclusion reduction in English acute psychiatry may be small. Seclusion reduction initiatives need to take a wider range of factors into account. Some substitution of seclusion with time-out may be possible, but a rigorous trial is required to establish this. The safety of intoxicated patients in seclusion requires more attention.
authors.affiliation: City University, London, United Kingdom. l.bowers@city.ac.uk
authors.forename: Len
authors.initials: L
authors.lastname: Bowers
authors.forename: Marie
authors.initials: M
authors.lastname: Van Der Merwe
authors.forename: Henk
authors.initials: H
authors.lastname: Nijman
authors.forename: Bridget
authors.initials: B
authors.lastname: Hamilton
authors.forename: Eric
authors.initials: E
authors.lastname: Noorthorn
authors.forename: Duncan
authors.initials: D
authors.lastname: Stewart
authors.forename: Eimear
authors.initials: E
authors.lastname: Muir-Cochrane
mesh_terms: D000208:Acute Disease; D003430:Cross-Sectional Studies; D004739:England; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D016012:Poisson Distribution; D011567:Psychiatric Department, Hospital; D012934:Social Isolation / Q000523:psychology*; D035502:Trust; D000078329:Workforce