Seclusion in a Moroccan Adult Psychiatry Unit

Despite significant advances in the pharmacological treatment of mental disorders, seclusion is still used in daily practice for patients hospitalized in Moroccan psychiatric institutions. Staff generally prefers to avoid using these procedures, as they limit the patient's freedom and undermine his or her dignity. However, it is sometimes necessary to do so to manage extreme episodes of dangerous behavior that threatens the safety of the patient and those around them. We aim in this study to identify the factors that impact the average duration of seclusion and to deduce, if possible, recommendations and measures to optimize or even reduce this time. This is a one-year retrospective study, conducted in the psychiatric department of IBN ROCHD University hospital in Casablanca-Morocco. The study includes data from 169 patients admitted during the entire year of 2018. Multivariate logistic regression analysis was employed to identify factors associated with the duration of seclusion. Based on the results of our study, it appears that the only socio- demographic factor that has a significant impact on the duration of the isolation is marital status. Also, for patients with a personal psychiatric history, the isolation was shorter. Furthermore, it was observed that patients who self-harmed resided longer in seclusion rooms. Regarding the medical diagnosis, it seems that schizoaffective disorder is the only diagnosis that leads to a longer period of isolation than others. Post-seclusion observations indicate that patients whose condition has deteriorated are placed in an extended placement. Although seclusion is not part of the patient's standard treatment, such an intervention may be implemented as an emergency treatment for patients exhibiting behavior that is dangerous to themselves or others. In addition, it would also be necessary to consider Morocco’s reality with its cultural aspects but also to deal with the lack of human and material resources from which our health care system suffers