What are adult psychiatric inpatients' experience of seclusion: A systematic review of qualitative studies

Abstract

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.

Patients’ perception of coercion with respect to antipsychotic treatment of psychotic disorders and its predictors

“…Coercive measures of all kinds, whether experienced by the patient or observed by others, are very stressful for the patient. This distress is closely linked to a negative assessment of psychiatric treatment in general and the experience of humiliation and feelings of shame and self-loathing [8][9][10][11][12].…”

“…In recent years, the subjective experience and evaluation of coercion from the perspective of patients and staff has been the subject of several studies (e.g., [10,12,21]). The subjective experience of coercion can make it difficult to build a trusting therapeutic alliance [18,[22][23][24][25].…”

Methods and Strategies for Reducing Seclusion and Restraint in Child and Adolescent Psychiatric Inpatient Care

“…Trauma-informed care should be distinguished from trauma-specific treatments (like Trauma-Focused Cognitive Behavioral Therapy) and is a much broader concept, aimed at transforming entire systems of care by embedding an understanding of traumatic responses at all levels. Trauma-informed care should be compassionate, noncoercive, nonviolent, learning, and collaborative [13,50]. Clients need to feel connected, valued, informed, and hopeful of recovery.…”

“…Dialectical Behavior Therapy (DBT) is an evidence-based treatment that directly addresses suicidal behavior and self-injury [49]. Tebbett-Mock et al (2020) [49] evaluated DBT versus treatment as usual (TAU) in a U.S. acute-care psychiatric inpatient unit for adolescents (age [12][13][14][15][16][17]. The DBT milieu treatment in the study included: DBT coaching, a token economy including an egregious (outside limits of the unit) behavior protocol requiring chain and solution analyses for egregious behaviors on the unit, therapeutic environment, resources for use of coping skills, DBT vocabulary, DBT skills groups (focusing on Mindfulness, Distress Tolerance, Emotion Regulation, Interpersonal Effectiveness and Middle Path), additional therapeutic and leisure groups (e.g.…”

“…Seclusion seems to be slightly more accepted among adolescents, when compared to mechanical restraints [9,12]. However, a systematic review covering adult psychiatric inpatients' experience of seclusion revealed that, during seclusion, patients felt vulnerable, neglected, and abused, disconnected from the experience, and felt it was dangerous to their mental health [13].…”