Accessible summary What is known on the subject? Seclusion involves isolating a patient in a room away from other patients in order to contain aggressive behaviour, and it is used in psychiatric hospitals. Research has found that seclusion is often viewed by patients as negative; however, there is limited in‐depth understanding of the deeply personal experience. What this paper adds to existing knowledge? This systematic review found that the published research may have flaws with the quality of analysis, mainly due to limited researcher reflexivity. The review of qualitative research revealed that during seclusion, patients feel vulnerable, neglected and abused, disconnected from the experience and that it is dangerous to their mental health. What are the implications for practice? For clinicians facilitating the seclusion process to use their therapeutic skills to provide patients with a sense of being cared for. For clinical supervision to allow space to explore interpersonal dynamics during seclusion in order to enhance therapeutic staff–patient interaction. Abstract IntroductionThere is limited understanding of patients' seclusion experience. A 2013 systematic review provides some insight; however, more knowledge is required in order to improve patient care. This is a systematic review of qualitative research into the patient experience of seclusion. The qualitative focus enables the phenomena to be the central focus. Question“What are adult psychiatric inpatients' experience of seclusion?” and “What is the quality of the applicable research?” MethodElectronic searches for qualitative research published between 2006 and 2017 were undertaken. Data were excluded if it was not explicitly related to seclusion. Research was appraised using three standardized appraisal criterion. Themes were generated through thematic synthesis. ResultsEight papers met inclusion criteria; four had been translated into English. Four themes were identified: “feeling vulnerable,” “feeling neglected and abused,” “disconnecting” and “seclusion is dangerous to mental health.” Participants felt vulnerable and without control. They experienced staff and room as neglectful and abusive. Participants mentally disconnected. The experience threatened participants' mental health. DiscussionParticipants' experience is an amalgamation of interpersonal experience and the environment. Disconnecting may be a coping strategy. Implications for practiceThe findings have implications for seclusion practice, staff training and clinical supervision. Specific attention needs to be paid to the staff–patient interaction.

What is known on the subject  Existing qualitative research has found inpatient service users to experience seclusion as highly distressing, with feelings of vulnerability, abuse and neglect often featuring in participants' accounts.  The physical environment of the seclusion room and the interaction with clinical staff shape service users' personal seclusion experience. What the paper adds to existing knowledge  The majority of research on this topic focuses on seclusion within other restrictive practices. This paper provides new knowledge on one specific component of seclusion, the experience of being in the room, and draws attention to the specific psychological needs of service users during that aspect of their experience.  This research provides new knowledge by exclusively exploring forensic inpatients' experience of the seclusion room, an under researched and often stigmatised population. What are the implications to practice  The findings support the need for a caring and non-threatening therapeutic interaction with a secluded service user for the duration of time they are in the seclusion room.  The findings suggest that necessary nursing procedures, such as observations, should be carried out discretely and sensitively to avoid service users feeling abused and frightened.

The findings suggest a reciprocal relationship between depression and ward atmosphere, and both factors are important in influencing a patient's motivation to engage with treatment. Improving motivation of psychiatric inpatients seems to require both factors to be addressed.

Stigma is an established consequence of the Borderline Personality Disorder (BPD) diagnosis. This diagnosis is subject to revision in the International Classification of Diseases-11th Revision (ICD-11). Using the legal issue of diminished responsibility, this study applied an experimental mock-jury methodology to explore the impact of diagnostic stigma of BPD on jury decision-making. Participants were allocated to one of two versions of a simplified fictitious homicide trial. The group whose defendant was described as having a 'severe personality disorder, borderline pattern' rated the defendant as more dangerous, and more in need of segregation and coercive treatment, than controls where the defendant was described as having a 'complex mental health problem'. Between-group differences in other measures, including the decision to agree a verdict of diminished responsibility, were not found. The ICD-11 'severe personality disorder, borderline pattern' diagnosis may adversely impact the attitudes of jurors considering the question of diminished responsibility.

The SCQ is a widely used screening measure for the assessment of autism spectrum disorder (ASD). However, its sensitivity and specificity when used with older children in the context of community Child & Adolescent Mental Health services is unclear. Seventy-seven (Mean age = 12.8 years) young people with suspected ASD were screened using parent-and teacherreported SCQ's before completing a comprehensive diagnostic assessment. Of the 77 young people included, 44 (57%) met criteria for an ASD diagnosis. Our results indicated that regardless of informant, SCQ scores did not significantly predict the outcome of the diagnostic assessment. Based on the published cutoff score for the SCQ, Receiver Operating Characteristic (ROC) curve analyses revealed a lower than expected sensitivity and specificity. This suggests that the SCQ is not an effective screening tool when used in the context of community Child & Adolescent Mental Health services.