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
In 2018–19, there were 11,944 seclusion events nationally in public sector acute mental health hospital services, which represents 7.3 seclusion events per 1,000 bed days. This is an increase from 11,316 seclusion events, or 6.9 seclusion events per 1,000 bed days in 2017–18. Overall, a downward trend 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 2014–15 to 2018–19 there has been an average annual reduction in the rate of national seclusion events of 2.2%.
States and territories
In 2018–19, the Northern Territory had the highest rate of seclusion in public sector acute mental health hospital services with 13.6 seclusion events per 1,000 bed days, compared with New South Wales, which had the lowest (6.0). Seclusion rates have fallen for three of the states and territories, and risen for four jurisdictions between 2017–18 and 2018–19 (Figure RP.2). However, 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.