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Chapter 19 - The Use of Seclusion in Mental Health Care

Published online by Cambridge University Press:  15 March 2024

By
Roland Dix  and
Mathew Page
Edited by
Roland Dix ,
Stephen Dye  and
Stephen M. Pereira
Roland Dix
Affiliation:
Gloucestershire Health and Care NHS Foundation Trust, Gloucester
Stephen Dye
Affiliation:
Norfolk and Suffolk Foundation Trust, Ipswich
Stephen M. Pereira
Affiliation:
Keats House, London
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Summary

Whether or not seclusion has a place within the treatment of the mentally disordered is one of the longest running debates in the history of mental health care, and it is likely to continue. Controversial deaths in mental health facilities and their subsequent inquiries will further fuel speculation as to how best to manage challenging behaviour. This chapter provides an overview of the history of seclusion, its value or otherwise, its alternatives and the necessary supporting policies for its use. It also offers a practical framework within which seclusion may be considered in the context of psychiatric intensive care units (PICUs).

Keywords

de-escalationdisturbed behaviourextra care area (ECA)low secure unit (LSU)Mental Health Act (MHA)physical restraintpsychiatric intensive care unit (PICU)rapid tranquilisationseclusion
Type
Chapter
Information
Psychiatric Intensive Care , pp. 245 - 258
Publisher: Cambridge University Press
Print publication year: 2024

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References

Al-Maraira, O and Hayajneh, F (2019) Use of Restraint and Seclusion in Psychiatric Settings: A Literature Review. Journal of Psychosocial Nursing and Mental Health Services 57 (4) 32–9.CrossRefGoogle ScholarPubMed
Angold, A (1989) Seclusion. British Journal of Psychiatry 154 (4) 437–44.CrossRefGoogle ScholarPubMed
Appelbaum, P (1999) Seclusion and Restraint: Congress Reacts to Reports of Abuse. Psychiatric Services 50 (7) 881–5.CrossRefGoogle ScholarPubMed
BBC (2011) BBC One – Panorama, Undercover Care: The Abuse Exposed. www.bbc.co.uk/programmes/b011pwt6.Google Scholar
Beauchamp, T and Childress, J (2019) Principles of Biomedical Ethics, 8th ed. Oxford: Oxford University Press.Google ScholarPubMed
Beer, D, Paton, P and Pereira, S (1997) Hot Beds of General Psychiatry: A National Survey of Psychiatric Intensive Care Units. Psychiatric Bulletin 21 (3) 42–4.CrossRefGoogle Scholar
Betemps, E and Buncher, M (1992) Length of Time Spent in Seclusion and Restraint by Patients at 82 VA Medical Centres. Hospital and Community Psychiatry 43 (9) 912–16.Google Scholar
Betemps, E. Somoza, E and Buncher, C (1993) Hospital Characteristics and Staff Reasons Associated with Use of Seclusion and Restraint. Hospital and Community Psychiatry 44 (4) 367–71.Google ScholarPubMed
Bowers, LA, Cullen, A, Achilla, E, Baker, J, Khondoker, M, Koeser, L, et al. (2017) Seclusion and Psychiatric Intensive Care Evaluation Study (SPICES): Combined Qualitative and Quantitative Approaches to the Uses and Outcomes of Coercive Practices in Mental Health Services. Southampton (UK): Health Services and Delivery Research.Google Scholar
Byrne, B, Alexander, C, Khan, O, Nazro, J and Shankley, W (2020) Ethnicity, Race and Inequality in the UK: State of the Nation. Bristol: Policy Press.Google Scholar
Care Quality Commission (CQC) (2020) A Review of Restraint, Seclusion and Segregation for Autistic People, and People with a Learning Disability and/or Mental Health Condition. CQC–464–102020.Google Scholar
Chamberlin, J (1985) An Ex-Patient’s Response to Soliday. Journal of Nervous and Mental Disease 173 (5) 288–9.CrossRefGoogle Scholar
Chieze, M, Hurst, S, Kaiser, S and Sentissi, O (2019) Effects of Seclusion and Restraint in Adult Psychiatry: A Systematic Review. Frontiers in Psychiatry 16 (10) 491.CrossRefGoogle Scholar
Craig, C and Hix, C (1989) Seclusion and Restraint: Decreasing the Discomfort. Journal of Psychosocial Nursing and Mental Health Services 27 (7) 16–19.CrossRefGoogle ScholarPubMed
Cullen, E, Bowers, L, Khondoker, M, Pettit, S, Achilla, E, Koeser, L, et al. (2016) Factors Associated with Use of Psychiatric Intensive Care and Seclusion in Adult Inpatient Mental Health Services. Epidemiology and Psychiatric Sciences 27 (1) 51–61.CrossRefGoogle ScholarPubMed
De Cangas, J (1995) Nursing Staff and Unit Characteristics: Do They Affect the Use of Seclusion? Perspectives in Psychiatric Care 29 (3) 15–22.CrossRefGoogle Scholar
De Cangas, J and Shopflocher, D (1989) The Practice of Seclusion and Factors Affecting Its Use. In Lo, C-H (ed.), Proceedings of the Sigma Theta Tau International Research Congress. Advances in International Nursing Scholarship Taipei: Sigma Theta Tau, p. 83.Google Scholar
Department of Health (2002) Mental Health Policy Implementation Guide: National Minimum Standards in Psychiatric Intensive Care Units (PICU) and Low Secure Environments. London: DOH.Google Scholar
Department of Health (2005) Survey of Physical Environments in PICU and LSUs in England and Wales.Google Scholar
Department of Health (2015) Mental Health Act 1983: Code of Practice. London: Department of Health.Google Scholar
Department of Health (2021) Mental Health Units (Use of Force) Act 2018: Statutory Guidance for NHS Organisations in England, and Police Forces in England and Wales. London: Department of Health.Google Scholar
Dix, R (2017) Seclusion: What’s in a Name? Journal of Psychiatric Intensive Care 13 (2) 57–9.CrossRefGoogle Scholar
Dix, R (2019) Restrictive Interventions and Seclusion: Time for Another Look. Journal of Psychiatric Intensive Care 15 (1) 1–3.CrossRefGoogle Scholar
Dix, R and Williams, K (1996) Psychiatric Intensive Care Units, a Design for Living. Psychiatric Bulletin 20 (9) 527–9.CrossRefGoogle Scholar
Doedens, P, Vermeulen, J, Boyette, L, Latour, C and de Haan, L (2020) Influence of Nursing Staff Attitudes and Characteristics on the Use of Coercive Measures in Acute Mental Health Services: A Systematic Review. Journal of Psychiatric and Mental health Nursing 27 (4) 446–59.CrossRefGoogle ScholarPubMed
Donat, D (1998) Impact of a Mandatory Behavioural Consultation on Seclusion/Restraint Utilisation in a Psychiatric Hospital. Journal of Behaviour Therapy and Experimental Psychiatry 29: 13–19.CrossRefGoogle ScholarPubMed
Elzubeir, K and Dye, S (2017) Can Amount and Duration of Seclusion Be Reduced in Psychiatric Intensive Care Units by Agreeing SMART Goals with Patients? Journal of Psychiatric Intensive Care 13 (2) 109–16(8).CrossRefGoogle Scholar
Foot, J (2015) The Man Who Closed the Asylums: Franco Basaglia and the Revolution in Mental Health Care. London: Verso.Google Scholar
Forster, PL, Cavness, C and Phelps, MA (1999) Staff Training Decreases Use of Seclusion and Restraint in an Acute Psychiatric Hospital. Archives of Psychiatric Nursing 13 (5) 269–71.CrossRefGoogle Scholar
Gajwani, R, Parsons, H, Birchwood, M and Singh, P (2016) Ethnicity and Detention: Are Black and Minority Ethnic (BME) Groups Disproportionately Detained Under the Mental Health Act 2007? Social Psychiatry and Epidemiology 51: 703–11.CrossRefGoogle ScholarPubMed
Gerlock, A and Solomons, H (1983) Factors Associated with the Seclusion of Psychiatric Patients. Perspectives in Psychiatric Care 1 (2) 46–53.Google Scholar
Griffiths, L (2001) Does Seclusion Have a Role to Play in Modern Mental Health Nursing? British Journal of Nursing 10 (10) 656661.CrossRefGoogle ScholarPubMed
Hammill, K (1987) Seclusion: Inside Looking Out. Nursing Times 83 (5) 38–9.Google ScholarPubMed
Hamolia, C (1995) Managing Aggressive Behaviour. In Stuart, G and Sundeen, S (eds.), Principles and Practice of Psychiatric Nursing, 5th ed. St Louis: Mosby. pp. 719–41.Google Scholar
Howe, A and Sethi, F (2018) Seclusion: The Untold Legacy of the Non-Restraint Movement in the UK. Journal of Psychiatric Intensive Care 14 (1) 5–13.CrossRefGoogle Scholar
Hunter, R and Macalpine, I (1963) Three Hundred Years of Psychiatry 1535–1860: A History Presented in Selected English Texts. London. Oxford University Press.Google Scholar
Infantino, J and Mustingo, S (1985) Assaults and Injuries Among Staff With and Without Training in Aggression Control Techniques. Hospital and Community Psychiatry 36: 1312–4.Google ScholarPubMed
Jensen, K (1985) Comments on Dr. Stanley M. Soliday’s Comparison of Patient and Staff Attitudes Towards Seclusion. Journal of Nervous and Mental Disease 173 (5) 290–1.CrossRefGoogle Scholar
Jones, R (2021) The Mental Health Act Manual, 24th ed. London: Sweet & Maxwell.Google Scholar
Khan, A, Cohen, S, Chiles, J, Stowell, M, Hyde, T and Robbins, M (1987) Therapeutic Role of a Psychiatric Intensive Care Unit in Acute Psychosis. Comprehensive Psychiatry 28 (3) 264–9.CrossRefGoogle ScholarPubMed
Kingdon, D and Bakewell, E (1988) Aggressive Behaviour: Evaluation of a Non-seclusion policy of a District Service. British Journal of Psychiatry 15: 631–4.Google Scholar
Kinsella, C and Brosman, C (1993) An Alternative to Seclusion? Nursing Times 89 (18) 62–4.Google ScholarPubMed
Klinge, A (1994) Staff Opinions About Seclusion and Restraint at a State Forensic Hospital. Hospital and Community Psychiatry 45 (2) 138–41.Google Scholar
Kuivalainen, S, Vehviläinen-Julkunen, K, Louheranta, O, Putkonen, A, Repo-Tiihonen, E and Tiihonen, J (2017) De-Escalation Techniques Used and Reasons for Seclusion and Restraint in a Forensic Psychiatric Hospital. International Journal of Mental Health Nursing 26 (5) 513–24.CrossRefGoogle Scholar
Kumar, A (1997) Sudden Unexplained Death in a Psychiatric Patient – A Case Report: The Role of the Phenothiazines and Physical Restraint. Medicine, Science, and the Law 37 (2) 170–5.CrossRefGoogle Scholar
Lanza, M and Campbell, R (1991) Patient Assault: A Comparison of Reporting Measures. Quality Assurance 5: 60–8.Google Scholar
Lavender, T and Shepherd, M (1999) Putting Aggression into Context: An Investigation into Contextual Factors Influencing the Rate of Aggressive Incidents in a Psychiatric Hospital. Journal of Mental Health 8 (2) 159–70.Google Scholar
Lomax, M (1922) The Experiences of an Asylum Doctor. London: George Allen & Unwin.Google Scholar
Mason, T (1993) Seclusion Theory Reviewed: A Benevolent or Malevolent Intervention? Journal of Medicine, Science and the Law 33: 1–8.Google ScholarPubMed
Mason, T (1994) Seclusion: An International Comparison. Medicine, Science and the Law 34 (1) 54–60.CrossRefGoogle ScholarPubMed
Meehan, T, Vermeer, C and Windsor, C (2000) Patients’ Perceptions of Seclusion: A Qualitative Investigation. Journal of Advanced Nursing 31 (2) 370–7.CrossRefGoogle ScholarPubMed
Merskey, H (1991) Shell-shock. In Berrios, G and Freeman, H (eds.), 150 Years of British Psychiatry, 1841–1991. London: Gaskell. pp. 245–67.Google Scholar
Mora, G (1967) History of Psychiatry. In Freeman, AM and Kaplan, HI (eds.), Comprehensive Text Book of Psychiatry. Baltimore: Williams and Wilkins.Google Scholar
Morales, T (1995) Least Restrictive Measures. Journal of Psychosocial Nursing and Mental Health Services 33 (10) 42–3.CrossRefGoogle ScholarPubMed
Morrison, P (1990) A Multi-Dimensional Scalogram Analysis of the Use of Seclusion in Acute Psychiatric Settings. Journal of Advanced Nursing 15: 59–66.CrossRefGoogle Scholar
Morrison, P (1995) Research on the Effects of Staffing Levels on the Use of Seclusion. Journal of Psychiatric Mental Health Nursing 2 (6) 365–6.CrossRefGoogle ScholarPubMed
Morrison, P and Lehane, M (1995) Staffing Levels and Seclusion Use. Journal of Advanced Nursing 55: 1193–202.Google Scholar
Morrison, P and Lehane, M (1996) A Study of the Official Records of Seclusion. International Journal of Nursing Studies 33 (2) 223–35.CrossRefGoogle ScholarPubMed
Musto, DF (1999) A Historical Perspective. In Bloch, S, Chodoff, P and Green, S (eds.), Psychiatric Ethics, 3rd ed. New York: Oxford University Press. pp. 1–23.Google Scholar
Myers, S (1990) Seclusion: A Last Resort Measure. Perspectives in Psychiatric Care 26 (3) 24–8.Google ScholarPubMed
National Association of Psychiatric Intensive Care Units and Low Secure Units (NAPICU) (2016) Position on the Monitoring, Regulation, and Recording of the Extra Care Area, Seclusion, and Long-Term Segregation Use in the Context of the Mental Health Act 1983: Code of Practice. Glasgow: NAPICU.Google Scholar
National Association of Psychiatric Intensive Care Units and Low Secure Units (NAPICU) (2014) National Minimum Standards for Psychiatric Intensive Care in General Adult Services. Glasgow: NAPICU.Google Scholar
National Institute for Care and Health Excellence (NICE) (2015) Violence and Aggression: Short-Term Management in Mental Health, Health, and Community Settings. London: NICE.Google Scholar
National Institute for Mental Health in England (NIMHE) (2004) Mental Health Policy Implementation Guide: Developing Positive Practice to Support the Safe and Therapeutic Management of Aggression and Violence in Mental Health Inpatient Settings. London: NIMHE.Google Scholar
Newman, J, Paun, O and Fogg, L (2018) Effects of a Staff Training Intervention on Seclusion Rates on an Adult Inpatient Psychiatric Unit. Journal of Psychosocial Nursing and Mental Health Services 56 (6) 23–30.CrossRefGoogle Scholar
Nolan, P (1989) Face Value. Nursing Times 85 (35) 62–5.Google ScholarPubMed
Nolan, P (1993) A History of Mental Health Nursing. London: Chapman Hall.Google Scholar
Norfolk, Suffolk and Cambridgeshire Strategic Health Authority (2003) Independent Inquiry into the Death of David Bennett. Cambridge: Norfolk, Suffolk and Cambridgeshire Strategic Authority.Google Scholar
Norris, M and Kennedy, W (1992) The View from Within: How Patients Perceive the Seclusion Process. Journal of Psychosocial Nursing and Mental Health Services 30 (3) 7–13.CrossRefGoogle ScholarPubMed
Orr, M and Morgan, J (1995) The Medical Management of Violence. In Kidd, B and Stark, C (eds.), Management of Violence and Aggression in Health Care. London: Gaskell.Google Scholar
Outlaw, FH and Lowery, BJ (1992) Seclusion: The Nursing Dhallenge. Journal of Psychiatric Nursing and Mental Health Services 30 (4) 13–17.CrossRefGoogle Scholar
Parkes, J (1996) Control and Restraint Training: A Study of Its Effectiveness in a Medium Secure Psychiatric Unit. Journal of Forensic Psychiatry 7 (3) 525–34.CrossRefGoogle Scholar
Parkes, J (2002) A Review of the Literature on Positional Asphyxia as a Possible Cause of Sudden Death During Restraint. British Journal of Forensic Practice 4 (1) 24–30.CrossRefGoogle Scholar
Patel, MX, Sethi, F, Barnes, N, Thomas, R, Dix, R, Luiz, D, et al. (2018) Joint BAP NAPICU Evidence-Based Consensus Guidelines for the Clinical Management of Acute Disturbance: De-Escalation and Rapid Tranquillisation. Journal of Psychiatric Intensive Care 14 (2) 89–132(44).CrossRefGoogle Scholar
Paterson, B, Bradley, P, Stark, C, Saddler, D, Leadbetter, D and Allen, D (2003) Deaths Associated with Restraint Use in Health and Social Care in the UK: The Results of a Preliminary Study. Journal of Psychiatric and Mental Health Nursing 10: 3–15.CrossRefGoogle Scholar
Paterson, B and Leadbetter, D (2004) Learning the Right Lessons. Journal of Mental Health Practice 7 (7) 12–15.CrossRefGoogle Scholar
Paterson, B, Leadbetter, D and McComish, A (1998) Restraint and Sudden Death from Asphyxia. Nursing Times 94 (44) 62–4.Google ScholarPubMed
Pereira, SM, Walker, L and Dye, S (2021) A National Survey of Psychiatric Intensive Care, Low Secure and Locked Rehabilitation Units. Mental Health Practice.CrossRefGoogle Scholar
Pilette, PC (1978) The Tyranny of Seclusion: A Brief Essay. Journal of Psychosocial Nursing and Mental Health Services 16 (10) 19–21.CrossRefGoogle Scholar
Pilowsky, LS, Ring, H, Shine, PJ, Battersby, M and Lader, M (1992) Rapid Tranquillisation. A Survey of Emergency Prescribing in a General Psychiatric Hospital. British Journal of Psychiatry 160: 831–5.CrossRefGoogle Scholar
Plasky, P and Coakley, C (2001) Reducing the Incidence of Restraint and Seclusion. In Dickey, B and Sederer, LI (eds.),Improving Mental Health Care: Commitment to Quality. Washington: American Psychiatric Association.Google Scholar
Plutchik, R, Karasu, T, Conte, H, Siegel, B and Jerrett, I. Toward a Rationale for the Seclusion Process. Journal of Nervous and Mental Disease 166 (8) 571–9.CrossRefGoogle Scholar
Prins, H (1994) Report of the Committee of Inquiry into the Death of Orville Blackwood and a Review of the Deaths of Two Other Afro-Caribbean Patients. London: Special Hospital Service Authority.Google Scholar
Parsons, A (2023) Powers of Restraint. Weightmans. www.weightmans.com/insights/powers-of-restraint/.Google Scholar
CQC (2020) A review of restraint, seclusion and segregation for autistic people, and people with a learning disability and/or mental health condition. October: CQC-464-102020Google Scholar
Renvoize, E (1991) The Association of Medical Officers of Asylums and Hospitals for the Insane, the Medico-Psychological Association, and Their Presidents. In Berrios, G and Freeman, H (eds.), 150 years of British Psychiatry, 1841–1991. London: Gaskell.Google Scholar
Rogers, A and Pilgrim, D (1996) Mental Health Policy in Britain: A Critical Introduction. London: Macmillan Press Ltd.CrossRefGoogle Scholar
Rosen, H and DiGiacomo, JN (1978) The Role of Physical Restraint in the Treatment of Mental Illness. Journal of Clinical Psychiatry 39: 228–32.Google Scholar
Royal College of Nursing (RCN) (2018) Report on Violence and Aggression in the NHS: Estimating the Size and Impact of the Problem. London: Royal College of Nursing.Google Scholar
Seligman, M and Feery, D (2006) Lord Steyn’s Lament. Journal of Psychiatric Intensive Care 2 (2) 111–17.CrossRefGoogle Scholar
Soliday, SM (1985) A Comparison of Patient and Staff Attitudes Towards Seclusion. Journal of Mental and Nervous Disease 173: 282–6.CrossRefGoogle Scholar
Soloff, PH (1979) Physical Restraining and the Non-Psychotic Patient: Clinical and Legal Perspectives. Journal of Clinical Psychiatry 40: 302–5.Google Scholar
Soloff, P, Gutheil, T and Wexler, J (1985) Seclusion and Restraint in 1985: A Review and Update. Hospital and Community Psychiatry 36 (6) 652–7.Google Scholar
Soloff, P and Turner, M (1981) Patterns of Seclusion. Journal of Nervous and Mental Disease 169 (1) 37–44.CrossRefGoogle ScholarPubMed
Steele, R (1993) Staff Attitudes Toward Seclusion and Restraint, Anything New? Perspectives in Psychiatric Care 29 (3) 23–8.Google ScholarPubMed
Stevenson, S (1991) Heading Off Violence with Verbal De-escalation. Journal of Psychosocial Nursing and Mental Health Services 29 (9) 6–10.CrossRefGoogle ScholarPubMed
Swett, C (1994) Inpatient Seclusion: Description and Causes. Bulletin of the American Academy of Psychiatry and the Law 22 (3) 421–30.Google ScholarPubMed
Tooke, S and Brown, J (1992) Perceptions of Seclusion: Comparing patient and staff Reactions. Journal of Psychosocial Nursing and Mental Health Services 30 (8) 23–6.CrossRefGoogle ScholarPubMed
Topping-Morris, B (1994) Seclusion: Examining the Nurse’s Role. Nursing Standard 8 (49) 35–7.Google ScholarPubMed
Turnbull, J, Aitken, J and Black, L (1990) Turn it Around: Short-Term Management of Aggression and Anger. Journal of Psychosocial Nursing and Mental Health Services 28 (6) 6–10.CrossRefGoogle ScholarPubMed
Wells, D (1972) The Use of Seclusion on a University Hospital Floor. Archives of General Psychiatry 26 (5) 410–13.CrossRefGoogle Scholar
Whittington, R and Mason, T (1995) A New Look at Seclusion: Stress, Coping, and the Perception of Threat. Journal of Forensic Psychiatry 6 (2) 285–304.CrossRefGoogle Scholar
Yurtbasi, M, Melvin, G, Pavlou, C and Gordon, G (2021) Nurse and Patient Factors: Predicting Seclusion in Adolescent Psychiatric Units. Journal of Child and Adolescent Psychiatric Nursing 34 (2) 112–19.CrossRefGoogle ScholarPubMed

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