Seclusion in the management of highly disturbed children and adolescents

Seclusion is the sole confinement of an individual in a room they are unable to freely exit. Seclusion is used on some child and adolescent inpatient psychiatric units to manage aggressive and threatening behaviors when less restrictive measures have failed. Due to the contentious nature of seclusion, many hospitals and schools aim to reduce or eliminate seclusion where possible. This chapter primarily provides an overview of prevalence, reasons for seclusion, and patient and environmental risk factors for seclusion that inform efforts to minimize the practice. The chapter also covers the use of seclusion in schools, ethical issues, the efficacy of seclusion, successful interventions that reduce seclusion rates, and relevant legislation and policy. It concludes by suggesting how changes can be made in the hospital system in order to reduce seclusion-use and promote best practice.