title: Measuring the impacts of seclusion on psychiatry inpatients and the effectiveness of a pilot single-session post-seclusion counselling intervention.
abstract: Despite the accumulation of evidence demonstrating patients' accounts of trauma associated with seclusion, the use of evidence-based post-seclusion debriefing is not apparent in the published work. This study aimed to identify the impacts seclusion has on an individual using the Impact of Events - Revised (IES-R), a standardized and widely used measure of trauma symptoms, and measure the effectiveness of a post-seclusion counselling intervention in mitigating the experience of seclusion-related trauma and reducing time spent in seclusion. The study design involved a comparison of the seclusion-related trauma and time in seclusion that was experienced by consenting patients managed on the two inpatient wards of Alfred Psychiatry. To investigate the efficacy of post-seclusion counselling to reduce event-related trauma as well as the use of seclusion, a brief single-session intervention was piloted comparing outcomes for patients treated on a ward implementing semistructured post-seclusion counselling and patients treated on a ward continuing with post-seclusion support as usual. A total of 31 patients consented to participate, with approximately 47% reporting trauma symptoms consistent with 'probable post-traumatic stress disorder' (IES-R total score, >33), although there was no difference in trauma experience between groups. Significantly fewer hours were spent in seclusion for patients treated on the ward piloting the post-seclusion counselling intervention. Findings, therefore, highlight not only the potential for significant trauma stemming from a seclusion event, but also the capacity for the implementation of such interventions as post-seclusion counselling to raise awareness of the need to minimize time spent in seclusion for patients.
authors.affiliation: Alfred Psychiatry, Australia.
authors.forename: Fiona
authors.initials: F
authors.lastname: Whitecross
authors.forename: Amy
authors.initials: A
authors.lastname: Seeary
authors.forename: Stuart
authors.initials: S
authors.lastname: Lee
mesh_terms: D000328:Adult; D003131:Combined Modality Therapy; D003376:Counseling / Q000379:methods*; D003419:Crisis Intervention / Q000379:methods; D005260:Female; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000451:nursing* / Q000523:psychology; D008875:Middle Aged; D010356:Patient Isolation / Q000523:psychology*; D010865:Pilot Projects; D011594:Psychometrics; D011614:Psychotherapy, Brief / Q000379:methods; D013313:Stress Disorders, Post-Traumatic / Q000175:diagnosis / Q000451:nursing / Q000523:psychology; D011795:Surveys and Questionnaires
keywords: post-seclusion counselling; practice change; seclusion; trauma