title: [Seclusion in emergency psychiatry].
abstract: BACKGROUND
  In Norway, seclusion (also called «shielding» or «open-area seclusion») is often used as an intervention in inpatient psychiatric wards as a continuation of milieu therapy, but the method remains controversial in health policy. A psychiatrist or occasionally a psychologist is responsible for making a decision on seclusion pursuant to Section 4-3 of the Mental Health Care Act. Because of the uncertainty regarding the content and academic legitimacy of this model, we have undertaken a review of available literature on the justification, practical application and effect of the Norwegian tradition of seclusion.
  
  
  METHODS
  The article is based on systematic searches in national and international databases for the years 1930-2013.
  
  
  RESULTS
  The seclusion method is closely associated with the development of psychiatric institutions, especially the establishment of emergency units and milieu therapy. The concept of seclusion covers a variety of approaches, and its knowledge base is generally poor. Clinical treatment studies are largely of older origin and most likely not descriptive of current practices. The absence of efficacy studies means that as of today, we have little knowledge on the benefits of using seclusion as treatment.
  
  
  CONCLUSIONS
  We detected a major discrepancy between the clinical ubiquity of the seclusion method and its knowledge basis. There is a clear need for more research on various types of seclusion to be able to assess the effects of seclusion in current practice.
authors.affiliation: Senter for medisinsk etikk Institutt for helse og samfunn Universitetet i Oslo.
authors.forename: Reidun
authors.initials: R
authors.lastname: Norvoll
authors.affiliation: Divisjon psykisk helsevern Akershus universitetssykehus og Institutt for klinisk medisin Universitetet i Oslo.
authors.forename: Torleif
authors.initials: T
authors.lastname: Ruud
authors.affiliation: Avdeling for akuttpsykiatri og psykosebehandling Sykehuset Innlandet, Reinsvoll.
authors.forename: Torfinn
authors.initials: T
authors.lastname: Hynnekleiv
mesh_terms: D003068:Coercion; D004637:Emergency Services, Psychiatric / Q000331:legislation & jurisprudence / Q000379:methods; D006801:Humans; D001523:Mental Disorders / Q000628:therapy; D008884:Milieu Therapy; D009664:Norway; D010356:Patient Isolation / Q000331:legislation & jurisprudence / Q000379:methods*