Seclusion and Mental Health

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1 Seclusion and Mental Health A break with the past RMN DPSN BA(Hons) Staff nurse, Mental Health Team, Southport and Formby Community Health Services NHS Trust, Merseyside, UK and RMN RNMH RGN BSc(Hons) Researcher,Ashworth Hospital, Maghull, UK Springer-Science+ Business Media, B. V.

2 First edition 1994 Springer Science+Business Media Dordrecht 1994 Originally published by Chapman & Hall in 1994 Phototypset in 10/12pt Palatino by Intype, London ISBN ISBN (ebook) DOI / Apart from any fair dealing for the purposes of research or private study, or criticism or review, as permitted under the UK Copyright Designs and Patents Act, 1988, this publication may not be reproduced, stored, or transmitted, in any form or by any means, without the prior permission in writing of the publishers, or in the case of reprographic reproduction only in accordance with the terms of the licences issued by the Copyright licensing Agency in the UK, or in accordance with the terms of licences issued by the appropriate Reproduction Rights Organisation outside the UK. Enquiries concerning reproduction outside the terms stated here should be sent to the publishers at the London address printed on this page. The publisher makes no representation, express or implied, with regard to the accuracy of the information contained in this book and cannot accept any legal responsibility or liability for any errors or omissions. that may be made. A catalogue record for this book is available from the British library library of Congress Catalog Card Number: fcio\ Printed on permanent acid-free text paper, manufactured in ~ accordance with ANSI/NISO Z and ANSI/NISO Z (Permanence of Paper).

3 Contents Preface Acknowledgements v vi 1 Introducing seclusion 1 and 2 History of the use of seclusion 17 3 Literature review 32 4 Seclusion as therapy, containment or punishment 49 5 Legal aspects and policy issues 65 6 Decision-making process in seclusion practice 82 7 Non-seclusion policies 95 and 8 Seclusion and nurse education Seclusion abuse 127 and 10 Ethical issues Patients' views about seclusion 161 and 12 Conclusions 174 and References 187 Index 199

4 Preface Seclusion as a concept is poorly understood and this is reflected in the literature on the topic, particularly from nursing authors. This has led to an emotionally charged altercation rather than academic debate, both within the literature and at conferences. But why bother learning about seclusion at all, particularly as it is used less and less within mental health? We would point out to those sceptical about the value of this book that seclusion is not only of interest as an intervention per se, but is valuable in reflecting a shifting ethos within care. For some reason, seclusion has been neglected; we believe that one reason is that it impinges upon widely held myths and beliefs within psychiatric practice. Questioning about seclusion uncovers uncomfortable facts and assumptions concerning the values underpinning today's mental health care approaches. Such uncomfortable questioning is often avoided for safer research pursuits. Also, we hold that this book is necessary in examining issues pertaining to seclusion practice. There is a gap within nursing knowledge in so far as seclusion is concerned, as our chapter on education upholds. Yet inquiries and litigation have highlighted the fact that seclusion practice must be more clearly understood as an intervention. At present, such understanding is erratic and far from useful in providing a higher standard of care. Practitioners need to make informed decisions regarding seclusion, and this book aims to provide the necessary information on which to base these decisions. We hope the book will appeal, not only to those in general and forensic psychiatric settings, but also to those in allied caring professions such as mental handicap and social work. It will be a useful text on many courses from Project 2000, post-basic courses and a wide range of diploma and degree courses in health care.

5 Acknowledgements In the long, and late, hours worked there are always those who are turned to for assistance and advice. The support comes in many forms, from boosting flagging confidences to more practical organization. Our special thanks are extended to Anne Beadle, Professor Ron Blackburn, Dianne Fawcett, Joyce Hampson, Dave Mercer, Frank Powell and Liz Whybourn for their help, advice, support and encouragement. Also to our respective spouses, Bill and Helen, for tolerating our mood swings as we worked on the manuscript!

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