Use of restraint and seclusion in psychiatric settings in New York State

Abstract

Objective: The authors examined rates of use restraint and seclusion during September 1992 in 125 psychiatric settings in New York State.

Methods: Psychiatric centers and general hospitals with psychiatric services were surveyed by mail about use of restraint and seclusion during a one-month period and about facility characteristics. Four measures of use of restraint and seclusion were calculated: percentage of patients restrained, percentage of patients secluded, rate of seclusion orders, and rate of restraint orders.

Results: Use of restraint and seclusion varied dramatically among the psychiatric settings studied. Use of restraint was not related to use of seclusion. Of the 112 tested relationships between facility and patient characteristics and variations in the restraint and seclusion measures, only 12 proved to be significant. None of the variables correlated significantly with variations in more than two of the four measures of restraint or seclusion, and only three correlated with at least two of the four measures.

Conclusions: Variations in use of restraint and seclusion in psychiatric settings in New York State are dramatic and difficult to correlate with differences in the patient populations. The authors suggest that such variations prevail because of the disparate clinical perspectives on the advisability of restraint and seclusion and the limited comparative monitoring of restraint and seclusion practices in psychiatric settings.