SPICES: Seclusion and Psychiatric Intensive Care Evaluation Study



Objectives: To assess the outcomes of seclusion and PICU care (study 1) and to describe differences in the management of disturbed patient behaviour related to differential availability (study 2).


Design: The electronic patient record system at one Trust was used to compare outcomes for patients who were and were not subject to seclusion or PICU, controlling for all other significant variables. Economic costs were also compared (study 1). Nursing staff at eight hospitals with differing access to seclusion and PICU completed attitudinal measures, a video test on restraint use timing, and an interview about the escalation pathway for the management of disturbed behaviour at their hospital. Analysis compared differences by access to seclusion or PICU (study 2).

Participants: Patients admitted to acute wards in one NHS Trust 2008-13 (study 1); nursing staff at eight randomly selected hospitals in England, with varying access to seclusion and PICU (study 2).

Main outcome measures: Aggressive behaviour, cost (study 1); utilisation, speed of use and attitudes to the full range of containment methods (study 2).

Results: Controlling for all other relevant variables, patients subject to seclusion or PICU compared to those who were not were more likely to be aggressive afterwards. The cost of their care was higher (study 1). Hospitals without seclusion rooms used more rapid tranquillisation, nursing of the patient in a side room accompanied by staff, and seclusion using an ordinary room. Staff at hospitals without seclusion rated it as less acceptable and were slower to initiate manual restraint. Hospitals without an onsite PICU used more seclusion, de-escalation, and within eyesight observation


Seclusion (isolation of a patient in a locked room) and transfer to psychiatric intensive care (PICU, a specialised higher security ward with higher staffing levels) are two common methods for the management of disturbed patient behaviour within acute psychiatric hospitals. Some hospitals do not have seclusion rooms or easy access to an onsite PICU. It is not known how these differences affect patient management and outcomes.


Len Bowers
Alexis Cullen 
Evanthia Achilla
John Baker
Mizanur Khondoker
Leo Koeser
Lois Moylan
Sophie Pettit
Alan Quirk
Faisil Sethi
Duncan Stewart
Paul McCrone
Alex Tulloch

Funding body

NIHR Service Delivery & Organisation, £335k


John Baker