The Disproportionate Use of Seclusion in a Children's Psychiatric State Hospital

Abstract

2418 consecutive seclusion episodes were examined for all patients (N = 408) in a child and adolescent psychiatric state hospital during a one-year interval. Results indicated an average duration of seclusion of over 5 hours for adolescents and over 4 hours for younger patients which was considerably longer than reported in prior studies. Males had significantly more seclusions than females, and nonwhites had almost twice the seclusion rate relative to whites. 15% of patients accounted for 73% of all seclusions. These children were younger, had more prior admissions, were more likely to be nonwhite, and to be diagnosed with a disruptive behavior disorder, relative to never secluded children. Results are discussed in regard to implications for seclusion use in child and adolescent facilities, and the impact on alternative treatments for the young, aggressive child who appears at high risk for overuse of seclusion.