Authors' reply

Reducing seclusion in psychiatric facilities often involves the coordination of a range of interventions to meet the needs of such organisations and their staff. ¹ In their response to our review, Scott & Dean have helpfully highlighted the need to tailor interventions to suit specific facilities through reminding readers of the differing determinants of emotional distress and aggression that are present for children and adults. These differences influence the reasons why children and adults are secluded.

In combining the literature on seclusion reduction initiatives at child, adolescent and adult psychiatric facilities, we do not contend that seclusion practices across these facilities, or the reasons for seclusion, are the same. We did, however, find no meaningful differences in the employment of seclusion reduction interventions between child, adolescent and adult facilities. Many of the interventions we found (e.g. monitoring seclusion episodes, staff education, changing the therapeutic environment) were used equally as often in child psychiatric units as they were in adult facilities.

Although the broad interventions for seclusion reduction appear similar between child and adult psychiatric facilities, the content of each type of intervention is likely to differ between facilities that serve specific populations. For example, staff education conducted at a child psychiatric unit to reduce seclusion may well be different to that provided at an adult psychiatric unit.

Our paper has provided the bare bones of a range of interventions that have been successfully used to reduce seclusion in psychiatric facilities. We welcome further comment, such as that from Scott & Dean, and the publication of seclusion reduction initiatives to help describe the ways in which these interventions can be applied in various types of facilities.