The use of seclusion in psychiatry: a literature review

This article reports on a literature review of the practice of seclusion in psychiatric inpatient facilities. Attention is paid to the moral debate on seclusion. Most publications consider seclusion as a necessary intervention to manage problem behavior. The first part of the article deals with definitional aspects leading toward concept clarification. The review shows differences in definitional aspects, motives for seclusion, hospital characteristics, and patient characteristics. Data on frequency, incidence, and duration appear to be widely divergent. The experiences of patients who have been secluded are mostly negative, but positive reactions are also reported. In the publications of the last decade, there is emphasis on the contribution of hospital characteristics to trends in use of seclusion. Finally, it is concluded that seclusion is an effective way to manage (potentially) dangerous behavior and that seclusion is an intervention that may create therapeutic possibilities for care.