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Do seclusion reduction initiatives increase risk to staff safety?

This resource looks at the evidence related to seclusion reduction and staff safety. The research questions are:

  • how does the literature describe the relationship between ward safety and seclusion reduction, in mental health and addiction inpatient units for adult or youth groups?
  • what are the factors that contribute to the reduction of seclusion while maintaining or promoting safety?


The publication in 2004 of the Six Core Strategies© (6CS) (Huckshorn, 2004) bolstered seclusion and restraint reduction initiatives in western nations. At about the same time, studies appeared suggesting that seclusion reduction initiatives could pose unique risks to the safety of staff. Although these studies have not been replicated, the perception of risk to personal safety associated with seclusion reduction initiatives remains a concern in mental health inpatient settings in New Zealand and elsewhere.

The success of seclusion reduction strategies will be limited or delayed as long as these initiatives are viewed as necessary for ward effectiveness and safety, and restrictions on its use are seen as unsafe. Balancing these two concerns places unique requirements on hospitals to ensure staff safety while honouring international conventions and New Zealand Ministry of Health policy to minimise coercion in mental health.

The outcome variables, limited to civil adult or youth mental health and addiction units, are:

conflict: patient-generated, other-directed verbal or physical aggression or violence

  • seclusion and other containment: staff-generated activities to limit conflict, with a focus on seclusion, manual or chemical restraint. Special attention is given to seclusion reduction in this review, but the term containment is used, where necessary, to ensure consistency with the variety of initiatives described here
  • safety: measured rates of assaults or injuries, regardless of reporting method.