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

Abstract

Seclusion is used in forensic and general mental health settings to protect a person or others from harm. However, seclusion can result in trauma-related harm and re-traumatization with little known about the experience of seclusion for consumers in forensic mental health settings from their perspectives. This article explores consumer experiences of seclusion in forensic mental health settings and explores the differences between female and male experiences of seclusion. Five electronic databases were systematically searched using keywords and variations of experience, attitude, seclusion, coercion, forensic mental health, and forensic psychiatry. Inclusion criteria were original peer-reviewed studies conducted in adult forensic mental health settings reporting data on the experiences of or attitudes towards seclusion. Seven studies met the criteria for inclusion and a quality assessment was undertaken. Results found consumers in forensic mental health settings perceive seclusion to be harmful, a punishment for their behaviour, and largely a negative experience that impacts their emotional health. Some consumers report positive experiences of seclusion. Differences in the experience of seclusion for females and males are unclear. Further research is required to understand the experience of seclusion for women in forensic mental health settings. Identification and consideration of differences in the experience of seclusion for males and females may assist in identifying sex-specific interventions and may inform policy and practices to eliminate or reduce the trauma associated with seclusion use.

Physical Restraint Experience of Patients with Mental Disorders in Mainland China: A Qualitative Study

“…Participants in this study reported unmet care needs during PR, such as neglect, lack of care and compassion by healthcare professionals, which is similar to findings in a number of related studies. 8 , 10 In many cases, the main cause of patient dissatisfaction with PR is the lack of contact with the nurse and the feeling of abandonment. 21 The lack of psychiatric nurses and lack of time make it difficult for staff to provide more time with restrained patients, which is the underlying cause of these feelings.…”

“… 9 To date, other countries have published a large number of studies on the qualitative experience of restraint in patients with mental disorders, and based on the findings, have developed PR reduction strategies that are suitable for their own national conditions, such as staff training, trauma-informed care, etc., which can reduce the use of PR and minimize trauma. 7 , 10 , 11 …”

Patient perspective on observation methods used in seclusion room in an Irish forensic mental health setting: A qualitative study

“…The seclusion of patients is often accompanied by negative experiences (Ezeobele et al., 2014). Several other studies have reported patients expressing a feeling of neglect and lack of care while in seclusion, ultimately portraying a lack of therapeutic connection and relation (Askew et al., 2019; Hansen et al., 2022; Holmes et al., 2015; Meehan et al., 2000; Ntsaba & Havenga, 2008). However, strong patient–staff relational contact during seclusion may ameliorate such adverse effects.…”

“…Current research on using seclusion in mental health has demonstrated diverse experiences of seclusion practices for the therapeutic relationship between patients and staff. These experiences may range from patients experiencing support and safety (Ezeobele et al., 2014; Iversen et al., 2011) to experiences of being in a situation of neglect and lack of care (Askew et al., 2019; Hansen et al., 2022; Holmes et al., 2015; Ntsaba & Havenga, 2008) and nurses' feelings of delivering extra care via seclusion (Holmes et al., 2015). Feeling a connection to staff and having relevant access to communication between patients and staff during seclusion has, however, commonly been underlined as a salient condition that may help promote strong patient–staff relationships that ameliorate the adverse effects of seclusion (Berg et al., 2023, Ezeobele et al., 2014, Askew et al., 2019).…”

“…Feeling a connection to staff and having relevant access to communication between patients and staff during seclusion has, however, commonly been underlined as a salient condition that may help promote strong patient–staff relationships that ameliorate the adverse effects of seclusion (Berg et al., 2023, Ezeobele et al., 2014, Askew et al., 2019). Moreover, it is commonly agreed the physical environment may promote or inhibit such contact and communication, and thereby draw correlations between the layout and function of seclusion rooms and their instruments and the possibilities for achieving desirable patient–staff relational outcomes (Askew et al., 2019; Hansen et al., 2022; Holmes et al., 2015).…”