Does ending night-confinement reduce use of seclusion and prevalence of violence in a forensic psychiatric hospital? A retrospective observational study.

Forensic psychiatry services strive to reduce the use of restrictive practices, and balance its occasionally necessary use with the creation of a therapeutic environment. There is limited research into the effects of least restrictive practice in forensic settings. The present retrospective observational study reviews the incidents of seclusion, restraint, and violence in a forensic psychiatric hospital one year before and one year after the introduction of a policy which ended night-confinement and allowed patients to exit their rooms overnight. The results show that there were fewer episodes of seclusion and fewer hours spent in seclusion post policy change, however this difference was not significant. There was no statistically significant difference in incidents of violence or in the use of physical restraint. While the research is of a small scale, it does suggest that policies ending night-confinement do not lead to increased seclusion episodes and encourages future research in this area.