The psychiatric intensive care unit
Chambers Mary in Psychiatric and mental health nursing, 2017
Seclusion, as defined by the Mental Health Code of Practice, is the ‘supervised confinement and isolation of a patient, away from other patients, in an area from which the patient is prevented from leaving’23 (p.300). The only clinical indication for the use of seclusion is to contain immediate and severely disturbed behaviour, and when there is an immediate threat to the safety of others. There are serious ethical considerations involved in the use of seclusion, and it should only be used as a last resort when all other clinical and therapeutic interventions, such as de-escalation and medication, have failed. Seclusion falls under the definition of medical treatment within the scope of the Mental Health Act (section 145). However, it should never be part of a planned intervention, and should not be used as a way of managing self-harming behaviour. The most important element of a clinician’s practice with regard to seclusion is that, once commenced, the clinician should begin immediately to work with the patient on a care plan that would support them to leave seclusion safely and quickly and return to the ward’s communal areas. The emphasis of practice should be on continued engagement and support to ensure that seclusion only occurs for the shortest time possible.
Forensic mental health services in the United Kingdom and Ireland
John C. Gunn, Pamela J. Taylor in Forensic Psychiatry, 2014
If seclusion is anything other than a means of emergency containment, it is probably the reduction in general stimulation coupled with limited but individualized attention which is beneficial for some patients. When secluded, however, patients are usually deprived of everything except clothes and bedding, and, for these, especially nondescript, toughened articles may be provided. The walls are bare, lighting is generally under staff control and the only means of external distraction is staff observation and evaluation. This is close to sensory deprivation, which is well documented as having adverse effects. It is likely that some of the so-called prison psychoses, documented around the turn of the last century (Nitsche and Williams, 1913), were secondary to the sensory deprivation of solitary confinement, and Grassian (1983) documented the onset of similar, apparently environmentally dependent disorders in a latter day American prison. No one any longer expects seclusion to be therapeutic for the mentally normal, or even for people with neurotic or personality disorders. Insofar as there may be a small positive effect for people with schizophrenia, with a possible reduction in hallucinatory experiences (Harris, 1959), improvement in body image and boundary (Reitman and Cleveland, 1964), and lowered symptoms for those who prefer withdrawal as a coping strategy (Mehl and Cromwell, 1969), such advantages might be achieved with reduction of sensory input way short of the harshness of locked away isolation.
Showing restraint
Bernadette McSherry, Yvette Maker in Restrictive Practices in Health Care and Disability Settings, 2020
Measurement must start with a clear underlying construct. Most restrictive practices are defined by the specific action involved. Seclusion is typically defined by the act of confinement of a person alone in a room or area from which free exit is prevented (see, for example, Mental Health Act 2013 (Tas): section 3(1)). The experience of the person in seclusion does not form part of the definition. If people are confined and not free to leave at their request, this is seclusion even if they have requested to be confined or are not aware of their situation (for example if they are sleeping).
Seclusion: A Patient Perspective
Published in Issues in Mental Health Nursing, 2020
Silvia Allikmets, Caryl Marshall, Omar Murad, Kamal Gupta
Mentally unwell patients who are violent present a critical risk to themselves, other patients and staff. As a result, effective, safe and humane intervention is necessary in emergency situations to prevent injury (Fisher, 1994). If de-escalation techniques fail, restraints, seclusion and/or rapid tranquilization can be considered, as allowable under local laws and regulations. Seclusion denotes the involuntary confinement of a patient in a minimally furnished, usually locked, room used when severely disturbed behaviour is likely to result in harm (Mental Health Act, 1983). Due to a lack of efficient alternatives, seclusion continues to be used. It is important to take into account patient perspectives of seclusion when considering what constitutes the best way of managing these vulnerable individuals.
A Quality Improvement Project Using Verbal De-Escalation to Reduce Seclusion and Patient Aggression in an Inpatient Psychiatric Unit
Published in Issues in Mental Health Nursing, 2021
Judy Haefner, Ifeoma Dunn, Marilyn McFarland
One of the interventions often used with agitated patients is seclusion (Knox & Holloman, 2012). Seclusion is viewed as a type of restraint which involves confining a patient to a locked room or an area restricting or forbidding free movements (Knox & Holloman, 2012). Seclusion, as an intervention to manage acutely disruptive and violent behaviors among patients in the psychiatric context, is a highly contentious issue. It is perceived by some as an infringement of basic human rights and dignity, while others believe it is an unavoidable intervention to maintain safety and control. Despite guidelines for promoting alternative interventions, data from the U. S. and Europe show that 10 to 30 percent of adolescents, adults, and older adult patients in psychiatric units still receive seclusion as the primary intervention for agitated behavior (Agency of Healthcare Research and Quality [AHRQ], 2015).
Music in Seclusion Rooms–Development, Implementation, and Initial Testing of a Music Listening Device
Published in Issues in Mental Health Nursing, 2019
Angelika Güsewell, Emilie Bovet, Cédric Bornand, Alexia Stantzos, Gilles Bangerter
Beyond the ethical issues, there is little evidence or certainty regarding the therapeutic effect of using seclusion rooms (SR). A systematic review of the literature published between 1985 and 2006 concluded that insufficient empirical evidence was available to consider seclusion as a safe and effective intervention in acute psychiatric inpatient settings (Nelstrop et al., 2006). Seclusion aims to reorganize the patient-nurse interaction in a sustained, containing and soothing manner (Vignat, 2009), to reduce space and to ritualize time, thereby enabling the patient to regain control of his or her psychic state and behavior and contribute to establishing (or restoring) a therapeutic alliance. However, most patients do not perceive the therapeutic function of seclusion (Bardet Blochet, 2009; Friard, 2009). Feelings of isolation and abandonment dominate, often accompanied by anger or anxiety (Bonner, Lowe, Rawcliffe, & Wellman, 2002; Holmes, Kennedy, & Perron, 2004; Martinez, Grimm, & Adamson, 1999; Meehan, Bergen, & Fjeldsoe, 2004; Wynn, 2004). Additionally, the reduction of sensory stimulation (i.e., hypostimulation) can present certain risks: “[when] deprived of the perception of external elements, the perception of one’s own body increases. This is worrying, as, generally speaking, we live in a silent body” (Bayard, 2011, p. 79). Since sensory deprivation, even of relatively short duration, can cause psychotic symptoms (Mason & Brady, 2009), it is recommended to intersperse the period of isolation with “moments of normal stimulation” (Bovet, 2009, p. 25).
Related Knowledge Centers
- Behaviour Therapy
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