Two-year Trends in the Use of Seclusion and Restraint Among Psychiatrically Hospitalized Youths

Objectives: This study examined characteristics associated with the use of seclusion and restraint among 442 psychiatrically hospitalized youths and sought to quantify changing trends in the rates of these modalities of treatment over time after the 1999 implementation of federal regulations and an institutional performance improvement program.

Methods: Demographic and clinical data related to all 5,929 incidents of seclusion and restraint that occurred during 2000 and 2001 at a child and adolescent state psychiatric hospital were analyzed.

Results: The two-year prevalence of use of seclusion was 61 percent and of restraint was 49 percent. Children and adolescents who were admitted on an emergency basis and those belonging to ethnic minority groups were more likely to undergo seclusion or restraint. Children aged 11 years and younger were more likely to undergo seclusion. The total number of episodes decreased by 26 percent and their cumulative duration decreased by 38 percent between the first quarter of 2000 and the last quarter of 2001. The decreases were the result of fewer seclusion and restraint incidents as well as shorter episodes of restraint. Over time, a concurrent increase was observed in the proportion of episodes associated with patient (but not staff) injuries and with as-needed use of medications.

Conclusions: National reforms and institutional efforts can lead to downward trends in the use of seclusion and restraint among psychiatrically hospitalized youths. The active elements of these interventions warrant further study and replication.