Trends in modern day mental health facilities have been towards the least restrictive
environment with emphasis on patients’ rights, but these rights have to be balanced
against the safety of both the patients themselves and anyone else in the immediate
environment. One way of restricting a person’s movement is through the use of
seclusion, a means of isolating a person in a locked room with minimal stimulus and
from where that person cannot freely exit.
This study was developed to explore the use of seclusion in an acute in-patient unit
for people with mental illnesses. Investigation into this issue was considered
important due to an identified large increase in seclusion use over the previous two
years.
The study used a qualitative research methodology with a descriptive and
interpretive approach. Data collection included a retrospective file audit of patients
who had been secluded over the past seven years, and one-to-one staff interviews. I
also included some personal reflections of seclusion events.
The principle reason for using seclusion was violence and aggression in the context
of mental illness. It was also used for people who were at risk of, or who had
previously absconded from the unit. A recovery approach and the use of the
strengths model was fundamental to nurses’ way of working with patients in the unit.
Nurses believed that the strengths process should be adapted to the person’s level of
acuity and to their ability to engage in this approach in a real and tangible way.
Seclusion continues to be a clinical management option in the unit that is the subject
of this study. It is used when a person is so unwell that they cannot be managed in
any other identified way. However, in many circumstances there are other options
that could be explored so that the utmost consideration is given to the dignity,
privacy and safety of that person
