Skip to main content Accessibility help
×
×
Home

Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services

  • A. E. Cullen (a1), L. Bowers (a1), M. Khondoker (a2), S. Pettit (a1), E. Achilla (a1), L. Koeser (a1), L. Moylan (a3), J. Baker (a4), A. Quirk (a5), F. Sethi (a6), D. Stewart (a7), P. McCrone (a1) and A. D. Tulloch (a1)...
Abstract
Aims.

Within acute psychiatric inpatient services, patients exhibiting severely disturbed behaviour can be transferred to a psychiatric intensive care unit (PICU) and/or secluded in order to manage the risks posed to the patient and others. However, whether specific patient groups are more likely to be subjected to these coercive measures is unclear. Using robust methodological and statistical techniques, we aimed to determine the demographic, clinical and behavioural predictors of both PICU and seclusion.

Methods.

Data were extracted from an anonymised database comprising the electronic medical records of patients within a large South London mental health trust. Two cohorts were derived, (1) a PICU cohort comprising all patients transferred from general adult acute wards to a non-forensic PICU ward between April 2008 and April 2013 (N = 986) and a randomly selected group of patients admitted to general adult wards within this period who were not transferred to PICU (N = 994), and (2) a seclusion cohort comprising all seclusion episodes occurring in non-forensic PICU wards within the study period (N = 990) and a randomly selected group of patients treated in these wards who were not secluded (N = 1032). Demographic and clinical factors (age, sex, ethnicity, diagnosis, admission status and time since admission) and behavioural precursors (potentially relevant behaviours occurring in the 3 days preceding PICU transfer/seclusion or random sample date) were extracted from electronic medical records. Mixed effects, multivariable logistic regression analyses were performed with all variables included as predictors.

Results.

PICU cases were significantly more likely to be younger in age, have a diagnosis of bipolar disorder and to be held on a formal section compared with patients who were not transferred to PICU; female sex and longer time since admission were associated with lower odds of transfer. With regard to behavioural precursors, the strongest predictors of PICU transfer were incidents of physical aggression towards others or objects and absconding or attempts to abscond. Secluded patients were also more likely to be younger and legally detained relative to non-secluded patients; however, female sex increased the odds of seclusion. Likelihood of seclusion also decreased with time since admission. Seclusion was significantly associated with a range of behavioural precursors with the strongest associations observed for incidents involving restraint or shouting.

Conclusions.

Whilst recent behaviour is an important determinant, patient age, sex, admission status and time since admission also contribute to risk of PICU transfer and seclusion. Alternative, less coercive strategies must meet the needs of patients with these characteristics.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Factors associated with use of psychiatric intensive care and seclusion in adult inpatient mental health services
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
*Address for correspondence: A. E. Cullen, Department of Psychosis Studies (PO67), Institute of Psychiatry, Psychology & Neuroscience, De Crespigny Park, London, SE5 8AF, UK. (Email: alexis.cullen@kcl.ac.uk; alex.tulloch@kcl.ac.uk)
References
Hide All
Barlow, K, Grenyer, B, Ilkiw-Lavalle, O (2000). Prevalence and precipitants of aggression in psychiatric inpatient units. Australian and New Zealand Journal of Psychiatry 34, 967974.
Bowers, L (2006). Psychiatric Intensive Care Units: a Literature Review. City University: London.
Bowers, L, Cullen, AE, Achilla, E, Baker, J, Khondoker, M, Koeser, L, Moylan, L, Pettit, S, Quirk, A, Sethi, F, Stewart, D, McCrone, P, Tulloch, AD (under revision). The seclusion and psychiatric intenstive care evaluation study. Health Services and Delivery Research.
Bowers, L, Jeffery, D, Bilgin, H, Jarrett, M, Simpson, A, Jones, J (2008). Psychiatric intensive care units: a literature review. International Journal of Social Psychiatry 54, 5668.
Brown, S, Bass, N (2004). The psychiatric intensive care unit: patient characteristics, treatment and outcome. Journal of Mental Health 13, 601609.
Cohen, S, Khan, A (1990). Antipsychotic effect of milieu in the acute treatment of schizophrenia. General Hospital Psychiatry 12, 248251.
Cornaggia, CM, Beghi, M, Pavone, F, Barale, F (2011). Aggression in psychiatry wards: a systematic review. Psychiatry Research 189, 1020.
Dack, C, Ross, J, Papadopoulos, C, Stewart, D, Bowers, L (2013). A review and meta-analysis of the patient factors associated with psychiatric in-patient aggression. Acta Psychiatrica Scandinavica 127, 255268.
El-Badri, SM, Mellsop, G (2002). A study of the use of seclusion in an acute psychiatric service. Australia & New Zealand Journal of Psychiatry 36, 399403.
Feinstein, A, Holloway, F (2002). Evaluating the use of a psychiatric intensive care unit: is ethnicity a risk factor for admission? International Journal of Social Psychiatry 48, 3846.
Flammer, E, Steinert, T, Eisele, F, Bergk, J, Uhlmann, C (2013). Who is subjected to coercive measures as a psychiatric inpatient? A multi-level analysis. Clinical Practice and Epidemiology in Mental Health: CP & EMH 9, 110119.
Gordon, H, Hammond, S, Veeramani, R (1998). Special care units in special hospitals. Journal of Forensic Psychiatry 9, 571587.
Healthcare Commission (2005). Count Me In. Results of a National Census of Inpatients in Mental Health Hospitals and Facilities in England and Wales. Healthcare Commission: London.
Hyde, CE, Waller, G, Wyn-Pugh, E (1992). Psychopathology and violent behaviour in psychiatric intensive care. Psychiatric Bulletin 16, 536537.
Iozzino, L, Ferrari, C, Large, M, Nielssen, O, de Girolamo, G (2015). Prevalence and risk factors of violence by psychiatric acute inpatients: a systematic review and meta-analysis. PLoS ONE 10, e0128536.
Keski-Valkama, A, Sailas, E, Eronen, M, Koivisto, AM, Lonnqvist, J, Kaltiala-Heino, R (2010). Who are the restrained and secluded patients: a 15-year nationwide study. Social Psychiatry and Psychiatric Epidemiology 45, 10871093.
Kirkpatrick, H (1989). A descriptive study of seclusion: the unit environment, patient behaviour and nursing interventions. Archives of Psychiatric Nursing III, 39.
Mattison, MR, Sacks, MH (1978). Seclusion: uses and complications. American Journal of Psychiatry 135, 12101213.
Mind (2011). Listening to Experience: An Independent Inquiry Into Acute and Crisis Mental Healthcare. London: Mind.
Molodynski, A, Khazaal, Y, Callard, F (2016). Coercion in mental healthcare: time for a change in direction. BJPsych International 13, 13.
Noda, T, Sugiyama, N, Sato, M, Ito, H, Sailas, E, Putkonen, H, Kontio, R, Joffe, G (2013). Influence of patient characteristics on duration of seclusion/restrain in acute psychiatric settings in Japan. Psychiatry and Clinical Neurosciences 67, 405411.
Noorthoorn, E, Lepping, P, Janssen, W, Hoogendoorn, A, Nijman, H, Widdershoven, G, Steinert, T (2015). One-year incidence and prevalence of seclusion: Dutch findings in an international perspective. Social Psychiatry and Psychiatric Epidemiology 50, 18571869.
Oldham, JM, Russakoff, LM, Prusnofsky, L (1983). Seclusion: patterns & milieu. Journal of Nervous and Mental Disorder 171, 645650.
Olofsson, B, Jacobsson, L, Gilje, F, Norberg, A (1999). Being in conflict: physicians’ experience with using coercion in psychiatric care. Nordic Journal of Psychiatry 53, 203210.
Pereira, S, Sarsam, S, Bhui, K, Paton, C (2006). The London survey of psychiatric intensive care units: psychiatric intensive care; patient characteristics and pathways for admission and discharge. Journal of Psychiatric Intensive Care 1, 1724.
Perera, G, Broadbent, M, Callard, F, Chang, CK, Downs, J, Dutta, R, Fernandes, A, Hayes, RD, Henderson, M, Jackson, R, Jewell, A, Kadra, G, Little, R, Pritchard, M, Shetty, H, Tulloch, A, Stewart, R (2016). Cohort profile of the South London and Maudsley NHS foundation trust biomedical research centre (SLaM BRC) case register: current status and recent enhancement of an electronic mental health record-derived data resource. BMJ Open 6, e008721.
Ramchandani, D, Akhtar, S, Helfrich, J (1981). Seclusion of psychiatric inpatients. International Journal of Social Psychiatry 27, 225231.
Stewart, R, Soremekun, M, Perera, G, Broadbent, M, Callard, F, Denis, M, Hotopf, M, Thornicroft, G, Lovestone, S (2009). The South London and Maudsley NHS foundation trust biomedical research centre (SLAM BRC) case register: development and descriptive data. BMC Psychiatry 9, 51.
Stolker, J, Hugenholtz, G, Heerdink, E (2005). Seclusion and the use of anti-psychotics in hospitalised psychiatric patients. Psychology, Crime and Law 11, 489495.
Van Der Merwe, M, Bowers, L, Jones, J, Muir-Cochrane, E, Tziggili, M (2009). Seclusion: a Literature Review. City University: London.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Epidemiology and Psychiatric Sciences
  • ISSN: 2045-7960
  • EISSN: 2045-7979
  • URL: /core/journals/epidemiology-and-psychiatric-sciences
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed