Book contents
- Frontmatter
- Contents
- List of contributors
- Preface to second edition
- Preface to first edition
- Foreword
- Part I Therapeutic interventions
- 1 Psychiatric intensive care – development and definition
- 2 Management of acutely disturbed behaviour
- 3 De-escalation
- 4 Rapid tranquillisation
- 5 Pharmacological therapy
- 6 Psychological approaches to the acute patient
- 7 Psychological approaches to longer-term patients presenting with challenging behaviours
- 8 Seclusion – past, present and future
- 9 Restraint and physical intervention
- 10 The complex needs patient
- 11 Therapeutic activities within Psychiatric Intensive Care and Low Secure Units
- 12 Risk assessment and management
- Part II Interface issues
- Part III Management of the Psychiatric Intensive Care Unit/Low Secure Unit
- Index
- References
8 - Seclusion – past, present and future
from Part I - Therapeutic interventions
Published online by Cambridge University Press: 22 August 2009
Book contents
- Frontmatter
- Contents
- List of contributors
- Preface to second edition
- Preface to first edition
- Foreword
- Part I Therapeutic interventions
- 1 Psychiatric intensive care – development and definition
- 2 Management of acutely disturbed behaviour
- 3 De-escalation
- 4 Rapid tranquillisation
- 5 Pharmacological therapy
- 6 Psychological approaches to the acute patient
- 7 Psychological approaches to longer-term patients presenting with challenging behaviours
- 8 Seclusion – past, present and future
- 9 Restraint and physical intervention
- 10 The complex needs patient
- 11 Therapeutic activities within Psychiatric Intensive Care and Low Secure Units
- 12 Risk assessment and management
- Part II Interface issues
- Part III Management of the Psychiatric Intensive Care Unit/Low Secure Unit
- Index
- References
Summary
Introduction
Whether seclusion has a place within the treatment of the mentally disordered is one of the longest running debates in the history of mental health care and it is likely to continue. Controversial deaths in mental health facilities and their subsequent inquiries will further fuel speculation as how best to manage challenging behaviour. The Independent Inquiry into the Death of David Bennett (Norfolk, Suffolk and Cambridgeshire Strategic Health Authority 2003) questioned whether the use of seclusion may have been preferable to prolonged restraint.
The use of seclusion is at least 2000 years old and many of the related questions have remained consistent, surviving to the modern day. It is not the intention of this chapter to re-describe the moral, ethical and legal paradigms that have punctuated much of seclusion's history. The focus here will be to provide an overview of the history of seclusion, its value or otherwise, its alternatives and the necessary supporting policies for its use. Finally, we will offer a practical framework within which seclusion may be considered in the context of Psychiatric Intensive Care Units (PICUs) and Low Secure Units (LSUs).
For the purpose of this chapter seclusion is defined as ‘the forcible confinement of a patient alone in a room for the protection of others from serious harm’ (Mental Health Act 1983: Code of Practice; Department of Health 1999).
Seclusion is widely used throughout the world (Mason 1994).
- Type
- Chapter
- Information
- Psychiatric Intensive Care , pp. 106 - 122Publisher: Cambridge University PressPrint publication year: 2008
References
1989 Seclusion. Br J Psychiatry 154: 437–444
1999 Seclusion and restraint: congress reacts to reports of abuse. Psychiatr Serv 50(7): 881–885Google Scholar
, 1994 Principles of Biomedical Ethics, 4th edn. Oxford: Oxford University Press
, , 1997 Hot Beds of general psychiatry: a national survey of psychiatric intensive care units. Psychiatr Bull 21: 142–144
, 1992 Length of time spent in seclusion and restraint by patients at 82 VA Medical Centres. Hosp Community Psychiatry 43(9): 912–916Google Scholar
, , 1992 Hospital characteristics and staff reasons associated with use of seclusion and restraint. Hosp Community Psychiatry 44(4): 367–371Google Scholar
1991 Assaultive behavaviour: does provocation begin in the front office?J Psychosoc Nursing Mental Health Serv 39: 21–26Google Scholar
1997 Coping With Aggressive Behaviour. Leicester: BPS Books
1997 Black people and sectioning. London: Little Rock Publishing, p. 47
, 1989 Seclusion and restraint: decreasing the discomfort. J Psychosoc Nurs Mental Health Serv 27(7): 16–19Google Scholar
1993 Nursing staff and unit characteristics: do they affect the use of seclusion?Perspect Psychiatr Care 29(3): 15–22Google Scholar
, 1989 The practice of seclusion and factors affecting its use. In: (ed) Proceedings of the Sigma Theta Tau International Research Congress. Advances in International Nursing Scholarship Taipei: Sigma Theta Tau, p. 83
Department of Health. 1983 Mental Health Act 1983: Code of Practice. London: Department of Health and Welsh Office
Department of Health. 1999 Mental Health Act 1983: Code of Practice. London: Department of Health
Department of Health. 2002 Mental Health Policy Implementation Guide: National Minimum Standards in Psychiatric Intensive Care Units (PICU) and Low Secure Environments. London: Department of Health
Department of Health. 2005 Survey of Physical Environments in PICU and LSUs in England and Wales. London: Department of Health
, 1996 Psychiatric Intensive Care Units, a design for living. Psychiatr Bull 20: 527–529Google Scholar
. 1998 Impact of a mandatory behavioural consultation on seclusion/restraint utilisation in a psychiatric hospital. J Behav Ther Exp Psychiatry 29: 13–19Google Scholar
Drinkwater J, Gudjonsson G. 1989 The nature of violence in psychiatric hospitals. In: , (eds) Clinical Approaches to Violence. Chichester: John Wiley and Sons Ltd, pp. 287–307
, , 1999 Staff training decreases use of seclusion and restraint in an acute psychiatric hospital. Arch Psychiatr Nurs 13 (5): 269–271
, 1983 Factors associated with the seclusion of psychiatric patients. Perspect Psychiatr Care 21(2): 46–53Google Scholar
2001 Does seclusion have a role to play in modern mental health nursing?Br J Nurs 10(10): 656–661Google Scholar
Hamolia C. 1985 Managing aggressive behaviour. In: Stuart G, Sundeen S (eds) Principles and Practice of Psychiatric Nursing, 5th edn. St Louis, Mo.: Mosby, pp. 719–741
, 1963 Three hundred years of psychiatry 1535–1860: a history presented in selected English texts. Oxford: Oxford University Press
, 1985 Assaults and injuries among staff with and without training in aggression control techniques. Hosp Community Psychiatry 36: 1312–1314Google Scholar
1985 Comments on Dr Stanley M. Soliday's comparison of patient and staff attitudes towards seclusion. J Nervous Mental Dis 173(5): 290–291Google Scholar
1999 Mental Health Act Manual, 6th edn. London: Sweet and Maxwell
, , , , , 1987 Therapeutic role of a psychiatric intensive care unit in acute psychosis. Compr Psychiatry 28: 3, 264–269Google Scholar
, 1988 Aggressive behaviour: evaluation of a non-seclusion policy of a district service. Br J Psychiatry 153: 631–634Google Scholar
1994 Staff opinions about seclusion and restraint at a state forensic hospital. Hosp Community Psychiatry 45: 138–141Google Scholar
1997 Sudden unexplained death in a psychiatric patient – a case report: the role of the phenothiazines and physical restraint. Med Sci Law 37: 170–175Google Scholar
. 1988 Evaluation of sudden death in psychiatric patients with special reference to phenothiazine therapy: forensic pathology. J Forensic Sci 33: 432–440Google Scholar
1922 The Experiences of an Asylum Doctor. London: George Allen & Unwin
1996 The role of talk down and talk up in managing threatening behaviour. J Psychosoc Nurs Mental Health Serv 34(6): 25–30Google Scholar
1993 Seclusion theory reviewed: a benevolent or malevolent intervention?J Med Sci Law 33: 1–8Google Scholar
, , 2000 Patients' perceptions of seclusion: a qualitative investigation. J Adv Nurs 31: 370–377Google Scholar
Merskey H. 1991 Shell-shock. in: Berrios G, Freeman H (eds) 150 years of British Psychiatry, 1841–1991. London: Gaskell, pp. 245–267
Mora G. 1967 History of psychiatry. In: Freeman AM, Kaplan HI (eds) Comprehensive Text Book of Psychiatry. Baltimore, Md.: Williams and Wilkins
1990 A multi-dimensional scalogram analysis of the use of seclusion in acute psychiatric settings. J Adv Nurs 15: 59–66Google Scholar
1995 Research in the effects of staffing levels on the use of seclusion. J Psychiatr Mental Health Nurs 2(6): 365–366Google Scholar
National Institute for Clinical Excellence. 2005 Violence: The Short-Term Management of Disturbed/Violent Behaviour in Psychiatric Inpatient Settings and Emergency Departments. London: NICE
National Institute for Mental Health in England. 2004 Mental Health Policy Implementation Guide: Developing Positive Practice to Support the Safe and Therapeutic Management of Aggression and Violence in Mental Health Inpatient Settings. London: NIMHE
1993 A History of Mental Health Nursing. London: Chapman Hall
Norfolk, Suffolk and Cambridgeshire Strategic Health Authority. 2003 Independent Inquiry into the Death of David Bennett. Cambridge: Norfolk, Suffolk and Cambridgeshire Strategic Health Authority. Available online at www.irr.org.uk/pdf/bennett_inquiry.pdf
, 1992 The view from within: how patients perceive the seclusion process. J Psychosoc Nurs 30(3): 7–13Google Scholar
Orr M, Morgan J. 1995 The medical management of violence In: Kidd B, Stark C (eds) Management of Violence and Aggression in Health Care. London: Gaskell
, 1992 Seclusion: the nursing challenge. J Psychiatr Nurs Mental Health Serv 30(4): 13–17Google Scholar
, 1995 Changes in the pattern of aggressive behaviour among inpatients with changed ward organisation. Acta Psychiatr Scand 91: 32–35Google Scholar
1996 Control and restraint training: a study of its effectiveness in a medium secure psychiatric unit. J Forensic Psychiatry 7(3): 525–534Google Scholar
. 2002 A review of the literature on positional asphyxia as a possible cause of sudden death during restraint. Br J Forensic Pract 4(1)Google Scholar
, , , , , . 2003 Deaths associated with restraint use in health and social care in the UK. The results of a preliminary study. J Psychiatr Mental Health Nurs 10: 3–15Google Scholar
, , 1999 Good practice issues in psychiatric intensive care units. Psychiatr Bull 23: 397–404Google Scholar
1978 The tyranny of seclusion: a brief essay. J Psychosoc Nurs Mental Health Services 16(10): 19–21Google Scholar
, , , , 1992 Rapid tranquillisation. A survey of emergency prescribing in a general psychiatric hospital. Br J Psychiatry 160: 831–835Google Scholar
Plasky P, Coakley C. 2001 Reducing the incidence of restraint and seclusion. In: , (eds) Improving mental health care: commitment to quality. Washington DC: American Psychiatric Publishing
, , , , 1978 Toward a rationale for the seclusion process. J Nervous Mental Disease 166(8): 571–579
. 1994 Report of the Committee of Inquiry into the Death of Orville Blackwood and a Review of the Deaths of Two Other Afro-Caribbean Patients. London: Special Hospital Service Authority
Reed Committee. 1992 Review of Health and Social Services for Mentally Disordered Offenders and Others Requiring Similar Services. London: Department of Health/Social Services Office
Renvoize E. 1991 The Association of Medical Officers of Asylums and Hospitals for the Insane, the Medico-Psychological Association, and their Presidents. In: , (eds) 150 Years of British Psychiatry, 1841–1991. London: Gaskell
1987 Psychiatric inpatients: perceptions of the seclusion room experience. Nurs Res 36: 234–238Google Scholar
, . 1996 Mental Health Policy in Britain: A Critical Introduction. London: Macmillan Press Ltd
, 1978 The role of physical restraint in the treatment of mental illness. J Clin Psychiatry39: 228–232Google Scholar
, 1999 Putting aggression into context: an investigation into contextual factors influencing the rate of aggressive incidents in a psychiatric hospital. J Mental Health 82(2): 159–170Google Scholar
1985 A comparison of patient and staff attitudes towards seclusion. J Mental Nervous Dis 173: 282–286Google Scholar
. 1979 Physical restraining and the non psychotic patient: Clinical and legal perspectives. J Clin Psychiatry 40: 302–305
, , . 1985 Seclusion and restraint in 1985: A review and update. Hosp Community Psychiatry 36(6): 652–657Google Scholar
1993 Staff attitudes toward seclusion and restraint, anything new?Perspect Psychiatr Care 29: 23–28Google Scholar
, 1992 Perceptions of seclusion: comparing patient and staff reactions. J Psychosoc Nurs 30(8): 23–26Google Scholar
, , 1990 Turn it around: short term management of aggression and anger. J Psychosoc Nurs 28: 6–12Google Scholar
1972 The use of seclusion on a university hospital floor. Arch Gen Psychiatry 26: 410–413Google Scholar
, 1995 A new look at seclusion: stress, coping and the perception of threat. J Forensic Psychiatry 6(2): 285–304Google Scholar
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