Understanding Women and Seclusion Use in a Forensic Mental Health Setting: A Retrospective Study

Abstract

Globally, efforts are underway to safely reduce and eliminate seclusion use in mental health settings. However, seclusion continues to be used in secure forensic hospitals despite well-known negative consequences for the person being secluded. Approaches for seclusion reduction have been implemented across a range of services, informed largely by research which focuses on men which may not be relevant for women in secure settings. Understanding of seclusion use for women remains somewhat limited. This study aimed to identify characteristics associated with the frequency and duration of seclusion for women admitted to a secure forensic hospital and examine the characteristics of women who did and did not experience seclusion. A retrospective cohort study was conducted using data collected from medical records for all women admitted to the study site between 1 January 2016 and 30 April 2021. Data included demographic, clinical and seclusion information. During the study timeframe there were 111 admissions, involving 82 individual women and 232 seclusion events, involving 48 women. Demographic and clinical factors associated with seclusion included women who were single and had children and women who had a history of child abuse/neglect. Women with a schizophrenia type diagnosis, personality disorder and or substance use/abuse disorder were more frequently secluded. Women who had experienced multiple traumas were more frequently secluded, however spent less time in seclusion compared to women with fewer experiences of trauma. This research may assist in early identification of women potentially at higher risk of experiencing seclusion, enabling earlier intervention, supporting the elimination of seclusion use at least for some women.