Seclusion: the association with diagnosis, gender, length of stay and HoNOS-secure in low and medium secure inpatient mental health service

Abstract

The use of seclusion is controversial. Using routinely collected data from low and medium secure service provider in the United Kingdom (n = 347) this study compared secluded and non-secluded Asperger’s syndrome, paranoid schizophrenia, organic personality disorder and emotionally unstable personality disorder patients. Analysis revealed that secluded patients were younger but did not differ on length of stay. Scores on the HoNOS-secure improved from entry to discharge on all diagnostic categories, indicating sensitivity to change. However, secluded patients with paranoid schizophrenia did not improve on the secure scale or personal and emotional well-being sub-scale factors, indicating HoNOS-secure should be used with caution in discharge decisions. Findings indicate that HoNOS-secure do not capture the factors linked to the use of seclusion in organic personality disorder and Asperger’s syndrome. HoNOS secure results outline differing needs and progress in the four diagnostic groups. Seclusion did not affect recovery as measured by HoNOS-secure clinical scale, providing evidence opposing the view that seclusion plays a major contribution to delaying recovery.

Keywords:

• Seclusion
• HoNOS
• recovery
• personality disorder
• schizophrenia
• Asperger’s