Seclusion

Seclusion is defined as the confinement of a patient at any time of the day or night alone in a room or area from which free exit is prevented. The purpose, duration, structure of the area and awareness of the patient are not relevant in determining what constitutes seclusion.

Seclusion also applies if the patient agrees to or requests confinement and cannot leave of their own accord. However, if voluntary isolation or ‘quiet time’ alone is requested and the patient is free to leave at any time then this social isolation or 'time out' is not considered seclusion.

While seclusion can be used to provide safety and containment at times when this is considered necessary to protect patients, staff and others, it can also be a source of distress for the patient and support persons, representatives, other patients, staff and visitors. Wherever possible, alternative less restrictive ways of managing a patient’s behaviour should be used, thus minimising the use of seclusion.

Seclusion and restraint may be used across the range of mental health services; however, the focus of the national data collections to date has been limited to the acute specialised mental health hospital service setting, since this service setting has been the focus of many of the associated quality improvement initiatives.

Overview

Seclusion data are available for each year from 2008–09. In 2019–20, there were 13,495 seclusion events nationally in public sector acute mental health hospital services, representing 8.1 seclusion events per 1,000 bed days, down from 18,251 in 2008–09. This is an increase from 11,944 seclusion events, or 7.2 seclusion events per 1,000 bed days in 2018–19. This is a change to the overall downward trend that has been observed since 2009–10 (the first year of full national data collection – a rate of 13.9 seclusion events). Over the period from 2015–16 to 2019–20 there has been an average annual increase in the rate of national seclusion events of 0.2% but an annual decline since 2009–10 of -5.2.

States and territories

In 2019–20, the Australian Capital Territory had the highest rate of seclusion in public sector acute mental health hospital services with 12.2 seclusion events per 1,000 bed days, and Western Australia had the lowest (5.0). Seclusion rates have fallen for four of the states and territories, and risen for the other four jurisdictions between 2018–19 and 2019–20 (Figure RP.2). Nationally, the average annual change in the rate of seclusion for this period was 0.2%. Data for smaller jurisdictions should be interpreted with caution as small changes in the number of seclusion events can have a marked impact on their overall seclusion rate. Further data quality information can be found in the data source section.

Figure RP.2: Rate of seclusion events, public sector acute mental health hospital services , states and territories, 2009-10 to 2019-20.

Line graph showing the seclusion rate per 1,000 bed days for all states and territories from 2009–10 to 2019–20. The long-term trend shows reductions in all states and territories, other than ACT and SA. Refer to Table RP.5.

Visualisation not available for printing

Source data: Restrictive practices 2019–20 tables (633KB XLS).

Frequency and duration

Nearly one in 25 (3.9%) episodes of care provided by in scope Australian public sector specialised acute hospital services involved a seclusion event in 2019–20, a decrease from 2013–14 (5.4%). The Northern Territory had the highest proportion of episodes with a seclusion event (6.4%), while Western Australia had the lowest (2.9%). Nationally, there were on average 2.5 seclusion events per episode of care with seclusion, which has increased from 2013–14 (2.1).

The average duration of a seclusion event excluding Forensic services, was 4.9 hours in 2019–20, down from 6.0 hours in 2013–14. New South Wales reported the longest average seclusion duration of 6.3 hours per seclusion event in 2019–20, and Western Australia (2.1 hours) had the shortest (Figure RP.3).

Figure RP.3: Average number of hours in seclusion per seclusion event, public sector acute mental health hospital services (exlcuding Forensic services), states and territories, 2013-14 to 2019-20.

Vertical bar chart showing the average number of hours spent in seclusion per seclusion event, 2013–14 to 2019–20. Four jurisdictions for which data are available had shorter durations in 2019–20 compared to 2013–14 (Victoria, WA, Tasmania and NT). Victoria was the highest for all years (9.5, 8.0, 8.3, 10.0, 8.3, 5.9) except 2019–20, in which NSW was the highest (6.3). SA reported seclusion duration for the first time in 2018–19, and shows an increase in average duration of seclusion from 1.8 hours to 2.3 in 2019–20. The national average reduced from 6.0 to 4.9. Refer to Table RP.5.

Visualisation not available for printing

Source data: Restrictive practices 2019–20 tables (633KB XLS).

Target population

Seclusion data can also be presented by the target population of the acute specialised mental health hospital service where the seclusion event occurred. Around three-quarters (77.8%) of in-scope care (total number of bed days) was provided in General services (unpublished data). Older person services accounted for 14.1% followed by Forensic (4.6%) and Child and adolescent (3.6%) services.

The highest rate of seclusion was for Forensic services with 30.4 seclusion events per 1,000 bed days, followed by Child and adolescent services (9.6), General services (8.2) and Older person services (0.2). General, Child and adolescent and Older person services show reductions in the rate of seclusion events from 2009–10 to 2019–20, whilst Forensic services show an increase. However, variability is apparent from year to year for all target populations (Figure RP.4).

 

Figure RP.4: Rate of seclusion events, public sector acute mental health hospital services, by target population, 2009-10 to 2019-20.

Line graph showing the rate of seclusion events per 1,000 bed days for the service unit target populations from 2009–10 to 2019–20. Most of the target populations show a decreasing rate of seclusion events from 2009–10 to 2019–20; General (15.4 to 8.2), Child and adolescent (11.4 to 9.6), Older person (3.2 to 0.2), & Mixed (13.3 to 10.0; data up to 2012–13 only). Forensic increased over the same period (12.0 to 30.4). Refer to Table RP.6. 

Visualisation not available for printing

Source data: Restrictive practices 2019–20 tables (633KB XLS).

Frequency and duration

Forensic services had the highest proportion of episodes of care involving seclusion events, with 19.1% of all mental health-related episodes involving at least one seclusion event in 2019–20. This was followed by General (4.1%), Child and adolescent (2.9%), and Older person (0.3%) services. Note that some data for Older person services have been suppressed due to low numbers (Figure RP.6).

Forensic services also had the highest frequency of seclusion, with an average of 9.8 seclusion events per episode when seclusion was used at least once during an episode of care. Seclusion events that occurred in Forensic services also had the longest average duration: 22.6 hours per seclusion event. General services reported an average time of 5.0 hours per seclusion event, followed by Child and adolescent (2.0 hours) services. The average time of a seclusion event decreased for General and Forensic service types between 2015–16 and 2019–20, but increased for Child and adolescent and Older person services in the same period.

Remoteness

Due to the small number of hospitals located in Outer regional and Remote areas, for the purpose of remoteness analysis these categories have been combined. There were no hospitals in the seclusion dataset located in Very Remote areas.

In 2019–20, hospitals located in Major cities had a seclusion rate of 8.2 events per 1,000 bed days. This rate was higher than for Inner regional facilities (7.0), and lower than Outer regional and Remote area facilities (10.2). The proportion of mental health-related admitted care episodes with a seclusion event was higher in facilities located in Major cities (3.9%), than Inner regional areas (3.7%) and lower than facilities in Outer regional and Remote areas (4.6%). Additionally, seclusion events in facilities in Major cities were on average longer in duration (5.1 hours) than Inner regional areas (4.5 hours) and Outer regional and Remote areas (3.1 hours).

Hospital level data

Figure RP.5 shows the variation in the seclusion rate across Australia in 2019–20. Note that data includes public sector acute mental health hospital services only and excludes forensic units. The variability in seclusion rates between hospitals may be due to a range of factors, including the hospital’s service delivery model, the number of acute mental health service units in the hospital, the patient casemix, and the target population of the service units. High numbers of seclusion events for a few individuals can also have a disproportional effect on the rate of seclusion reported. Data for individual hospitals should also be interpreted with caution as small changes in the number of seclusion events can have a marked impact on their overall seclusion rate.

Figure RP.5:  Rate of seclusion, public sector acute mental health hospital services, hospital level, 2018-19.

Horizontal bar chart showing the rate of seclusion events in public sector acute mental health hospital services by hospital, excluding forensic units, in 2019–20, ordered from highest to lowest. The highest seclusion rate is 43.6 seclusion events per 1,000 bed days. Several hospitals had a seclusion rate of 0 recorded. Refer to Table RP.11.

Visualisation not available for printing