The Mentally Ill and Social Exclusion: A Critical Examination of the Use of Seclusion From the Patient's Perspective

Abstract

Nurses in psychiatric settings have an important role to play in the application of seclusion, a measure that continues to be a frequently used intervention for the management of disturbing patient behaviours. Albeit a controversial measure, isolating patients remains a common institutional practice that has received widespread attention from a political, ethical, legal, and clinical standpoint. Although there is an abundance of scientific work on the subject, few studies have examined the experience of patients being confined. In order to improve the quality of nursing care surrounding this measure it appeared essential to obtain data on patients' perspectives, information deemed valuable in orienting nursing interventions. This qualitative study, guided by a phenomenological research design, aimed at describing and gaining a better understanding of patients with a severe and persistent psychiatric disorder who were placed in a seclusion room while hospitalized on a closed psychiatric unit. Using a semi-structured, non-directive interview format, a total of six patients participated in this study. Content analysis of participants' narratives yielded three main themes that appeared to be central to their experience of seclusion: their experience of seclusion on an emotional level, their perception of this intervention, and how they coped during their stay in the seclusion room. Major findings emerging from this nursing study centred on the following dimensions: patients' perceptions of seclusion as a punitive measure and a modality for social control and, the experience of seclusion serving as an intensification of already existing feelings of exclusion, rejection, abandonment, and isolation. In addition the findings also suggest that it is not seclusion per se that impacts on their negative perception and negative emotional experience but rather the lack of nurse-patient contact during the seclusion experience. Furthermore, whether patients coped by regressing, acting out, or taking on a more compliant stance, they appeared to be motivated by a need to connect with staff. This points to the importance of the relational aspects of nursing care when applying this restrictive measure. A need for modifying the institutional culture surrounding seclusion and transforming nursing practices are discussed as are future research endeavours.

Coercion and the Corruption of Care in Mental Health Nursing: Lessons from a Case Study

“…As isolation can potentially be used punitively, many countries regulate the use of seclusion rooms to protect against the risk of abuse. Patients' experiences of seclusion in mental health units have been reported to intensify their feelings of being less worthy, of being abandoned or rejected (Holmes et al, 2004). It is worth emphasising that isolation does not require the use of a seclusion room.…”

“…In psychiatric settings, isolation and seclusion are employed in certain circumstances to protect the patient or those around them (Holmes, Kennedy, & Perron, 2004;Horsfall & Cleary, 2003). As isolation can potentially be used punitively, many countries regulate the use of seclusion rooms to protect against the risk of abuse.…”

Patient Experience of Coercive Measures

“…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).…”

Les chambres fermées en psychiatrie: poursuivre le débat pour dépasser les conflits

“…La plupart des études restituent la parole du patient de manière descriptive et rétrospective; par cette démarche, elles apportent des éléments nécessaires à la compréhension du conflit des logiques qui oppose soignés et soignants. Dans la perspective du patient, l'aspect thérapeu-tique de la mise en chambre fermée n'est pas un acquis [5,9]; au contraire, l'isolement est souvent perçu comme une mesure punitive, un moyen de contrôle social où s'intensifient des sentiments déjà présents d'exclusion, de rejet et d'abandon [10]. La perception des patients au sujet de l'isolement n'est cependant pas univoque.…”