Experiencing Seclusion in a Forensic Psychiatric Setting

Abstract

In hospital settings, and especially in forensic psychiatric ones, restlessness, aggression, and even violence are familiar issues to healthcare workers. Under these circumstances, the need for restrictive measures (seclusion, mechanical/chemical restraints) is sometimes needed. Although such measures should be considered as exceptional interventions, they continue to be widespread in general, psychiatric, and forensic psychiatric settings. Although there is a great deal of literature on a myriad of issues associated with the use of seclusion, very little research has focused on the lived experience of the seclusion room in forensic psychiatric settings, whether from the patient's perspective or from the perspective of nursing staff responsible for these patients. Such an examination could help ameliorate the experience of secluded forensic psychiatric patients while informing nursing staff about the impacts of seclusion. This article reports the results of a federally funded qualitative, phenomenological research study conducted in a Canadian forensic psychiatric environment. Our results show that the "structure of place" matters for both patients who experience seclusion and nursing staff who work therapeutically in these settings. "Place" is irreducible to the physical "space" in which bodies find themselves; this study of place took into consideration the ways the lived body experiences seclusion and interrelates with others. Although there can be no doubt that many patients who experience seclusion are oftentimes objectively at risk, with a heightened potential to self-harm and to harm other inpatients and nursing staff as well, as our study participants attested, the bodies secluded in this space are not "objects."

Patients’ experiences of isolation in psychiatric inpatient care: Insights from a meta‐ethnographic study

“…The food served during seclusion was not the same quantity and quality as that served to other patients on the ward (Holmes et al . ). Patients also described violent staff behaviour, which made them feel more like animals than human beings who were suffering (Mayers et al .…”

‘I know what I need to recover’: Patients’ experiences and perceptions of forensic psychiatric inpatient care

“…For patients to feel involved, they must be invited and heard in discussions and dialogue; rather than just receiving information, they need to be engaged in their own care through mutual trust (Livingston et al 2013;Selvin et al 2016). Patients may experience that coercive measures are used in their best interest, to prevent them from doing things they would regret (Holmes et al 2015;Tingleff et al 2019). Staff setting limits in an empathic, authoritative manner can be perceived as positive (Maguire et al 2014).…”

Impact of the implementation of the safewards model on the social climate on adolescent psychiatric wards

“…Indeed, safety has been widely emphasized on psychiatric wards, both among inpatients and staff. Safety is still the most important factor that affects the decision to use containment measures on psychiatric wards (Holmes et al ; Korkeila et al ). Moreover, Jackson et al () explored the decision‐making processes of mental health staff in ending seclusion and reported that one overriding theme in it was safety.…”