| Summary: | This study aims to determine the number of patients secluded over a specified period,
provide a profile of patients that are likely to be secluded, and to ascertain the reasons for
seclusion.
Seclusion in the psychiatric context can be defined as the involuntary confinement of an
agitated, unstable person alone in a contained, controlled environment. There are differing
views on seclusion and consequently this has presented clinicians with an ethical dilemma.
Significant morbidity and mortality have been associated with seclusion. In light of this,
alternatives to seclusion have been explored. No data exists in South Africa on rates of
seclusion for psychiatric purposes, and consequently neither the need for seclusion nor
alternatives to seclusion have been explored.
The study is a retrospective review of patients secluded at Sterkfontein Hospital, a tertiary
psychiatric hospital, over a six month period. Data was collected from clinical records at
Sterkfontein Hospital.
RESULTS: 112 patients were secluded over the 6 month period. Users were secluded for a
total of 59415.5 hours and on 4814 separate occasions. 84.8% of the users secluded were
male. The mean age of users secluded was 29years. Just over half the users (52%) were
secluded for their own safety and 40% of users were secluded for aggression (either
physical or verbal). The commonest diagnosis was Schizophrenia (31.4%) followed by
Cognitive Impairment (20.6%) and Bipolar Mood Disorder (13.7%). The most commonly
used medication was Sodium Valproate (17%), followed by Haloperidol (11%) and
Risperidone (11%).
CONCLUSION: Younger male patients with psychosis were most likely to be secluded. More
research should be conducted locally to compare seclusion in terms of rates and patient
profiles so that we may improve seclusion practices.
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