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Medical guidelines for PICU seclusion reviews

Published online by Cambridge University Press:  11 July 2013

Vishal Bhavsar ,
Faisil Sethi  and
Bradley Hillier
Vishal Bhavsar*
Affiliation:
ST4, South London and Maudsley NHS Foundation Trust
Faisil Sethi
Affiliation:
Consultant Psychiatrist, South London and Maudsley NHS Foundation Trust
Bradley Hillier
Affiliation:
Locum ST4-6, South London and Maudsley NHS Foundation Trust
*
Correspondence to: Dr Vishal Bhavsar, Pyschosis Clinical Academic Group, Maudsley Hospital, London SE5 8AZ. E-mail: [email protected]
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Abstract

Evidence regarding medical practice in seclusion is limited, and far outweighed by opinion. Here, we present one approach to medical reviews of patients in seclusion rooms, aiming to drive consistent practice. We address the work of clinicians prior to their arrival in the seclusion area, information-gathering prior to entry into the seclusion room, relevant aspects of history-taking and mental state examination in the seclusion area, and the implications for clinical and risk-management. We discuss issues raised by the logistics of seclusion for the planning and undertaking of the consultation. Physical examinations of secluded patients are commonly complicated by patient-related and environment-related factors; we suggest a pragmatic approach to determining the scope of physical examination in seclusion. While risk assessments are a vital aspect of seclusion practice for psychiatrists, structured instruments for the assessment of risk within these environments do not exist. We lay out principles regarding risk assessment in this population. We comment on the role of the clinician in the debrief phase of the seclusion review, and deal with legal issues pertaining to seclusion in England. Ultimately, we are left with a number of questions relating to what constitutes best practice for psychiatrists fulfilling this role on the PICU.

Keywords

Seclusionmanagementrisk
Type
Review Article
Information
Journal of Psychiatric Intensive Care , Volume 10 , Issue 1 , April 2014 , pp. 40 - 50
Copyright
Copyright © NAPICU 2013 

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References

Beer, M.D., Paton, C., Pereira, S. (1997) Hot beds of general psychiatry: a national survey of psychiatric intensive care units. Psychiatric Bulletin. 21(3): 142–144.Google Scholar
Beer, M.D., Pereira, S.M., Paton, C. (2008) Psychiatric Intensive Care, 2nd edition.Cambridge University Press, 369 pp.CrossRefGoogle Scholar
Department of Health. (2008) Code of Practice: Mental Health Act 1983. TSO, London. http://www.lbhf.gov.uk/Images/Code%20of%20practice%201983%20rev%202008%20dh_087073%5B1%5D_tcm21-145032.pdfGoogle Scholar
Douglas, K.S., Ogloff, J.R., Nicholls, T.L., Grant, I. (1999) Assessing risk for violence among psychiatric patients: the HCR-20 violence risk assessment scheme and the Psychopathy Checklist: screening version. Journal of Consulting and Clinical Psychology. 67(6): 917–930.Google Scholar
Jagarlamudi, K., Portillo, G., Dubin, W.R. (2012) Countertransference effects in acutely disturbed inpatients. Journal of Psychiatric Intensive Care. 8(2): 105–112.CrossRefGoogle Scholar
Junginger, J. (1990) Predicting compliance with command hallucinations. American Journal of Psychiatry. 147(2): 245–247.Google Scholar
Mason, T. (1994) Seclusion: an international comparison. Medicine, Science and the Law. 34(1): 54–60.Google Scholar
McNiel, D.E., Eisner, J.P., Binder, R.L. (2000) The relationship between command hallucinations and violence. Psychiatric Services. 51(10): 1288–1292.CrossRefGoogle ScholarPubMed
Mullen, P.E. (2006) Schizophrenia and violence: from correlations to preventive strategies. Advances in Psychiatric Treatment. 12(4): 239–248.Google Scholar
Munjaz v UK (2012) 2913/06 MHLO 79 (ECHR).Google Scholar
National Institute for Health and Clinical Excellence. (2005) Violence: The short term management of disturbed and violent behaviour in inpatient psychiatric settings and emergency departments. Clinical Guideline 25. NICE, 83pp.Google Scholar
National Institute for Health and Clinical Excellence (2009) Borderline Personality Disorder: Treatment and management. Clinical Guideline 78. London: NICE.Google Scholar
Otto, R.K. (2000) Assessing and managing violence risk in outpatient settings. Journal of Clinical Psychology. 56(10): 1239–1262.Google Scholar
Rogers, P., Watt, A., Gray, N.S., MacCulloch, M., Gournay, K. (2002) Content of command hallucinations predicts self-harm but not violence in a medium secure unit. The Journal of Forensic Psychiatry. 13(2): 251–262.Google Scholar
Rogers, R., Gillis, J.R., Turner, R.E., Frise-Smith, T. (1990) The clinical presentation of command hallucinations in a forensic population. American Journal of Psychiatry. 147(10): 1304–1307.Google Scholar
Wells, D.A. (1972) The use of seclusion on a university hospital psychiatric floor. Archives of General Psychiatry. 26(5): 410–413.Google Scholar