Contributors to seclusion use in adult mental health inpatient units across organization for economic cooperation and development countries: A systematic literature review

Abstract

BackgroundThe use of seclusion remains a controversial practice in psychiatric care, raising human rights concerns.ObjectiveTo synthesize and analyse evidence on factors contributing to the use of seclusion in adult mental health inpatient units across countries within the Organization for Economic Cooperation and Development (OECD).MethodsA comprehensive literature search was conducted following the PRISMA guidelines, with focus on studies published until 28^th February 2025, which reported on use of seclusion or similar restrictive practices in adult psychiatric inpatient units. The Covidence tool was used for full-text screening, data extraction, and initial quality assessment.ResultsThe review identified complex interactions among factors influencing seclusion, with variation in findings related to patient demographics and clinical characteristics, staff attributes, and ward conditions. Organizational and political factors were less frequently examined; however, available evidence suggested progressive policy frameworks were associated with lower seclusion rates.ConclusionThis review highlights the need to reconceptualise seclusion practices, advocating an integrated approach that incorporates socio-cultural and policy-level interventions alongside patient and staff factors. Further research is needed to inform policy and practice on seclusion use in adult mental health settings across OECD countries.