Seclusion is a clinical intervention used in psychiatric inpatient settings that focuses on the management of violent and aggressive behaviour when the behaviour compromises the safety of the service user and others. The therapeutic effect of seclusion has always been a controversial issue in psychiatry. Some consider seclusion to be necessary and therapeutic for the control of violent behaviour while others consider it a violation of human rights and a form of punishment. In the DHB inpatient unit it is seen as a necessary evil and is used as a last resort in managing severely disturbed and aggressive behaviour. In recent years great effort has been made in national and international level to reduce seclusion use and there are strict guidelines both in law and policy determining how it is to be used. Definition
The New Zealand Health and Disability Service standards define seclusion as “where a consumer is placed alone in a room or area, at any time and for any duration, from which they cannot freely exit”. (Ministry of Health, 2008) “Seclusion involves:
Containment – a person is contained within a room where the door is shut and the freedom to exit is decided by staff. Isolation – the person is in the room alone.
Reduction of sensory input – the room is reasonably bare, often containing no more than a bed and sometimes a toilet” (Mental Health Commission, 2004)
Because of its intrusive nature and the potential for misuse, interventions such as seclusion or physical restraints are always been a controversial issue in psychiatric history. In 18th century patients who proved difficult to control were often isolated for long periods (sometimes many years) and were frequently also maintained in physical restraints. Seclusion was implemented as a punishment, to intimidate and exclude (Farrell & Dares, 1996)