Being in a Seclusion Room: The Forensic Psychiatric Inpatients’ Perspective

Abstract

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.

What do we know about the experience of seclusion in a forensic setting? An integrative literature review

“…The authors note, while study participants did not make allegations of abuse occurring, staff actions were interpreted as abusive; participants described that they felt like victims of staff abuse (Askew et al . 2019). Further, staff behaviour was seen as deliberate neglect (Askew et al .…”

“…Participants described staff having control over the duration and experience of their seclusion, resulting in participants being passive for seclusion to cease (Askew et al . 2019). One participant described seeking power (due to feeling powerless) by refusing to leave the room or openly masturbating.…”

“…The seclusion space was also described as boring and demoralizing (Holmes et al 2015) and claustrophobic (Hui 2017). Askew et al (2019) found that the physical aspects of the seclusion experience were associated with fear in relation to staff and the environment. One participant described being fearful when and how staff entered the seclusion room (in response to hiding and covering of the observation panel) '.…”

“…They don't really talk to you, they don't care' and one participant stated '[nurses] are just as capable of violence as the patients are' (Holmes et al 2015, p. 205). Similarly, feelings of neglect and abandonment were identified, which challenged the expectation of care (Askew et al 2019). One participant described being 'left (by staff)' and another stated '.…”

“…The studies reflected a range of perceptions in relation to staff interaction, received attention, and quality of care during seclusion. Experiences ranged from staff being perceived to be caring, skilled, and supportive to staff being perceived in a negative light (Haw et al 2011) or hard to interact with (Hui 2017), to patients feeling neglected or abused (Askew et al 2019). Keski-Valkama et al (2010) found that some participants reported feelings of indifference towards staff interaction, which were interpreted to reflect participants' cynical attitudes derived from seclusion.…”