Is locked seclusion necessary for children under the age of 14?

Article Abstract:

Much controversy surrounds the use of inpatient seclusion for therapeutic purposes. There is the negative connotation of solitary confinement or punishment connected with this practice, which may obscure the therapeutic objectives. In 1987, Pennsylvania prohibited the use of locked seclusion for children under 14 years old who are inpatients in psychiatric facilities. A retrospective analysis of the effect this policy has had was conducted, with emphasis on the clinical implications it may have for the patients. A 32-bed unit with three subdivisions for severely emotionally disturbed children was involved in the analysis. One unit served as an admission unit containing children with psychiatric disorders ranging in severity. The second unit contained facilities for younger children with conduct disorders, and the third housed older children who were considered to require a less structured environment as a result of previous therapeutic success. Three units of time were examined where locked seclusion, unlocked seclusion, or unlocked seclusion with privileges determined by the behavioral level of the patient was maintained. Factors also considered were the daily number and total duration of seclusions, staff-patient ratios, and the amount and variability of medications administered. The overall effect of discontinuing locked seclusion was perceived to be negative. Therapeutic intervention by locked seclusion may be needed for patients with severe behavioral disorders. Unlocked seclusion was correlated with an increased need for drugs and the clustering of several patients requiring medication. This was especially observed among those children who were more disturbed behaviorally. These results indicate that additional studies are required to assess in more detail the risk-benefit ratio of the use of locked seclusion. Factors to consider include patient characteristics, the effect this practice has on the staff, and the clinical impact on the patient. (Consumer Summary produced by Reliance Medical Information, Inc.)

Ethical aspects, Psychiatric hospital care, Psychiatric hospital patients, Psychiatric hospitals, Patient isolation

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Response to the presidential address: our children: our future

Article Abstract:

In 1994 the APA will be 150 years old. Some desired goals for this date include reduced defense spending and increased spending on domestic programs for youth, the poor, and the unemployed, groups that are most susceptible to mental and emotional disorders. Unfortunately, few people are concerned with the research or financial support needed to treat poverty and other social aspects of mental illness. The job of psychiatry is to facilitate desperately needed treatment for children, even if compensation is uncertain, as children are the future. As adults, we all serve as parental figures and role models. It is time that we refocus our public and political attention on how we treat our children. It is finally understood that child care issues must be worked out, but other children's issues are also gaining more attention. Academic performance is declining, child abuse is epidemic, and mental and emotional illness among children under the age of 18 years is higher than ever before. The 1980s saw a dramatic increase in the number of children placed outside of the home because of a breakdown in the family. Many of these children need mental health care, and receive very little. It is our obligation to provide a wholesome environment for own children. Psychiatric care must become available to all children who need it, and funding for social programs is mandatory to achieve this. It is especially important that research funding for investigating the social causes of mental illness be provided. In the 1890s it was recognized that the well-being of children was the key to the development of a responsible adult citizenry; the 1990s must renew this focus on the physical and mental well-being of children. Children, adolescents and their families need to be treated with care and compassion if society is to have a positive future. (Consumer Summary produced by Reliance Medical Information, Inc.)

Social aspects, Political aspects, Child psychiatry, editorial

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