Reducing the use of seclusion in a forensic psychiatric hospital: assessing the impact on aggression, therapeutic climate and staff confidence

Against the background of an emerging international demand, this study examined the impact of a suite of interventions designed to reduce the use of seclusion in a forensic psychiatric hospital. These interventions included a review of existing seclusion practices and staff training in the management of aggression as well as the implementation of evidence-based alternatives. Evaluation occurred via pre- and post measurements of (1) therapeutic climate, (2) staff attitudes towards seclusion, (3) staff confidence to manage aggression, (4) the frequency and duration of seclusion episodes and (5) the frequency of aggression. The results revealed a significant reduction in the use and duration of seclusion episodes. Although staff appeared to use seclusion less frequently to manage a similar number of aggressive incidents there was no deterioration in staff perceptions of personal safety, nor any change in staff confidence to manage aggressive patients. There was also no change to therapeutic climate or staff attitudes towards seclusion. The clinical implications and opportunities for future research are discussed.