Seclusion rates and patient census in a maximum security hospital

Seclusion incidents were studied irr an undercrowded maximum security hospital where seclusion is used in response to episodes of violent or disruptive behavior. Population-based seclusion rates for days with an above-mean census were compared with those for days with a below-mean census. Contrary to expectations derived from studies of overcrowded prisons, the total seclusion rate was higher under low census conditions. Although the seclusion rate for parasuicide incidents was higher under high census conditions, seclusion rates for battery, assault, and disorderly conduct incidents were each higher under low census conditions. These findings are interpreted as indicating that correctional officers observe a smaller proportion of battery, assault, and disorderly conduct incidents under high census conditions. Such underdetection must be taken into account, along with underreporting, in studies of intrainstitutional incidents.