Seclusion: the inside story

Abstract

The objective of this study was to gain a better understanding of the seclusion room experiences of chronic psychiatric patients, the way in which they cope with their seclusion room experience, and the effect of seclusion on subsequent relations with care providers. A qualitative research design was used, in line with the procedure of Grounded Theory. Semi-structured interviews were held with seven chronic psychiatric outpatients whose seclusion took place at a certain remove in time. The transcriptions were analyzed with the aid of Winmax. The following results were found. Most seclusion experiences by far are negative. However, patients whose experience took place a considerable time ago also mention positive experiences. It is hard to come to terms with the seclusion experience; this is a matter of learning to live with it (adaptation) rather than assimilating it (adjustment, or active coping and controlling). Factors conducive to the coping process are: understanding the reason why it took place, time, distraction, possibilities to discuss it with others, and quick recovery of control. Factors prohibitive to the coping process are: the danger of recurrence, iniquitous treatment by care providers during seclusion, confrontation with others being secluded, and lack of opportunity to talk about it. Seclusion does not affect subsequent relation with care providers, with two exceptions. When patients feel they have been treated iniquitously during seclusion, or when seclusion continues to be a daily threat, this has a negative effect on relations with care providers. The central themes of this study are autonomy, trust, and loneliness.

Impacts of Seclusion and the Seclusion Room: Exploring the Perceptions of Mental Health Nurses in Australia

“…Where consumers experience a loss of autonomy and trust and experience a sense of loneliness and isolation, the impact on the nursepatient relationship is likely to be negatively affected by the use of seclusion. These findings support those of similar research (Hoekstra et al, 2004;Holmes et al, 2004;Meehan et al, 2000;Wynaden et al, 2001).…”

“…The potential impact on the nurse-consumer relationship was described in a study from the Netherlands (Hoekstra, Lendemeijer, & Jansen, 2004). The responses from consumers reflected three major themes.…”

Patient Experience of Coercive Measures

“…Patients hospitalised more than once might be more familiar with the treatment system, adapted to their symptoms to some extent and had lowered their expectations of their living conditions and well-being (Kahneman et al 2004). Hoekstra et al (2004) concluded that the reasons for earlier secluded/restrained patients' positive experiences of coercion were associated with adaptation; learning to live with the experience rather than assimilation, active coping and control. Other factors during hospitalisation may also have impacted upon results: patients' recovery (Ristner et al 2011), psychoeducation received (Pitkänen et al 2011;Michalak et al 2005), therapeutic relationships between patients and nurses (Michalak et al 2005), or characteristics of the wards.…”

“…Even though there are studies on patients' experiences of seclusion dating back to the 1970s and 1980s (Wadeson and Carpenter 1976;Binder and McCoy 1983;Soliday 1985;Hamill et al 1989;Mann et al 1993), interest in this theme has increased since about 2000 (Meehan et al 2000;Hoekstra et al 2004;Holmes et al 2004;Meehan et al 2004;Sørgaard 2004;Wynn 2005;Chien et al 2005;Stolker et al 2006;Steinert et al 2007;El-Badri and Mellsop 2008;Keski-Valkama et al 2010a;Kontio et al 2012).…”

“…Adaptation to the illness and treatment system as well as experiences of earlier coercive measures have been shown to influence patients' perception of coercive measures (Hoekstra et al 2004;Georgieva et al 2012). Patients hospitalised more than once might be more familiar with the treatment system, adapted to their symptoms to some extent and had lowered their expectations of their living conditions and well-being (Kahneman et al 2004).…”