Understanding the factors that influence whether or not staff seclude service users will help reduce instances of this controversial intervention, say Janet Kai Ling Wong and colleagues

This literature review aims to discover the factors that influence staff working on psychiatric intensive care units (PICUs) to implement seclusion. Identifying these factors may help to reduce the use of seclusion and improve client care. A comprehensive search of available publications was undertaken, with relevant articles analysed and discussed. The main factors identified were staff and service-user characteristics, with an increase in shift workload, aggression on both sides and client-to-staff ratio contributing to an increased use of seclusion. Environmental factors also played an important part, with smaller unit size leading to lower rates of seclusion.

A re-evaluation of the design and layout of PICUs may enable a decrease in the use of seclusion. In addition, increasing the number of staff working on a unit might improve issues such as organisation, staff confidence and the ability to adopt alternative de-escalation techniques. This review shows that further study is needed in this area, particularly on the different health professional roles in a PICU.