Eliminating seclusion: first 24h after inpatient admission is critical

The first 24 hours after admission to mental health inpatient services is a critical period in working towards eliminating seclusion events, according to research recently published by Te Pou. Nearly two-thirds (61 percent) of first seclusion episodes occur in the first 24 hours, and a large proportion of these occur within the first hour of admission.

The research

The work was recently published in the Journal of Psychiatric and Mental Health Nursing. The research came out of the Te Pou least restrictive practice initiative, which supports services to eliminate the use of seclusion as it can be harmful and traumatising for people.

In previous research and practice, we noticed that seclusion events often occur soon after admission and wanted to investigate this further to understand how this can be prevented. This work involved an analysis of the seclusion data within the Programme for the Integration of Mental Health Data (PRIMHD) national database collected by Manatū Hauora.

The project team included researchers, data analysts, Māori advisors, lived experience advisors, and clinical advisors. This collaborative approach strengthens the research, making it more meaningful and impactful.

The need

Inpatient admission can be highly distressing for tāngata whaiora and whānau, so it is important to prioritise whanaungatanga (building connections and relationships) and manaakitanga (showing hospitality, kindness, and respect). There also needs to be a strong focus on de-escalation. It is important to prioritise people-led and trauma-informed de-escalation strategies that reduce distress, such as the use of therapeutic communication and sensory modulation.

Key results

As well as demonstrating the crucial importance of the first 24 hours, the research shows that men, Māori, and Pasifika are at a heightened risk of being secluded soon after inpatient admission.

Other key factors that significantly raise the likelihood of seclusion include clinician perceptions of certain behaviours (such as aggression) and referrals from police or justice services. It is important to be aware of these contributing factors to help develop non-coercive preventative strategies that support the elimination of seclusion.

The research also found that recent contact with community mental health services appears to reduce the likelihood of seclusion.

Get in touch

If you have any questions about this research and the least restrictive practice initiative at Te Pou, please contact Caro Swanson and Kerry Weir-Smith.