Factors contributing to mental health professionals' decision to use seclusion.

OBJECTIVE: The authors constructed an explanatory model of factors contributing to the decision to use seclusion. METHODS: Experts helped develop 64 vignettes that manipulated multiple patient and environmental variables. Eighty-two mental health professionals working on inpatient wards in four institutes in the Netherlands rated the vignettes. A univariate general linear model examined vignette variables and rater characteristics influencing the decision to use seclusion. RESULTS: Almost half of the decision to seclude (46%) could be explained by a combination of rater characteristics and vignette variables. Rater characteristics explained 31.7%, and vignette variables explained 27.9% (with a 13.6% interaction effect). Rater characteristics, in order of explanatory influence, were type of care provided by the professional (such as on a crisis-intensive care or an observation-diagnostic unit), current frequency of participation in seclusion, the specific institute where the professional was employed (of the four participating institutes), experience using seclusion (number of years), and being in training to be a psychiatrist or a community mental health nurse. The primary vignette variables, in order of influence, were the approachability of the patient, seriousness of danger, availability of patient rooms and space, primary diagnosis, the professional's perceived trust in colleagues, staff-patient ratio during the shift, and voluntary or involuntary status. CONCLUSIONS: The model explained nearly half of the decision by mental health professionals to seclude vignette patients. Rater characteristics were at least as important as patient variables, including problem behaviors and diagnosis, and ward features. Because perceived approachability of the patient was a key factor, seclusion reduction policies should focus on supporting professionals in their efforts to manage inpatients with problem behaviors in an appropriate way.