Locking Up Illness- Seclusion and the Mentally ILL.
Is behaviour management such a dangerous issue in general mental health units that the practice of seclusion should be maintained as a practice for people experiencing a mental illness?
What if any are the therapeutic benefits for the patient of such a practice?
Who are the people making the decision to seclude an individual?
In Australia today, it is still a practice to lock patients into a “seclusion room” for unspecified periods of time. This can include patients admitted to mental health units on a voluntary basis. True, a person who is secluded must first be deemed involuntary, but as this is a simple paperwork issue it is dealt with quickly and with a minimum of fuss and with little recourse for the patient.
In youth MH it is a behaviour management tool. As most Child MHUs are part of most capital city's major hospitals they are invariably over-crowded and under-resourced so often nursing staff take a punitive line when trying to manage negative or aggressive behaviours in YP. This practice is used on the most vulnerable group of patients in the mental health sector.
For ITO patients seclusion only reinforces the negative perception the patients have of their situation. It is totally disempowering and I don't believe it engenders any kind of future cooperation from these patients, if indeed that were the end consideration.
A seclusion room is not as benign as the term might suggest. In fact thirty years ago are seclusion room was simply that. A room. A room with wide plexiglass windows and a simple door with a locking mechanism. Apart from the window and the lock it looked as much like any other room in a MHU. These rooms were furnished with a low bed built as a single piece and mounted on the floor. There was lighting and a light switch and the beds had the normal linen one would expect on a bed.
Today a seclusion room is a much different animal. It is a small three metre by three metre room with no windows of any kind, a recessed light fitting, a mattress on the floor and a steel reinforced door with food tray slots and a viewing slot. The door itself is exactly the same as those used in isolation cells in prison. As with prison the lighting control are not interior but are controlled by an external switch operated by staff. So light can be provided or withdrawn at will and at the whim of MHU staff. The saddest part is, every general MHU has these cells as part of their infrastructure.
The National Mental Health Consumer and Carer Forum recently drafted a paper regarding the practice of seclusion in Australian mental Health units. http://www.nmhccf.org.au/documents/Seclusion%20&%20Restraint.pdf
The organisation stated that it was its position that the use of seclusion was an easy way out in dealing with the challenging behaviours of mentally ill patients
The Queensland Government’s Department of Health stated in review policy http://www.health.qld.gov.au/mentalhealth/docs/sandrpolicy_081030.pdf
It’s drive to reduce and eventually eliminate the use of seclusion and restraint from its MHUs.
I think it can be argued that in extreme instances seclusion may be the only option to deal with certain behaviour management issues. Seclusion though is still used as a punitive measure as a reaction to non-compliance or non-cooperation, whether some professionals care to admit it or not. I have seen it and sadly, experienced it. But my main point is the seclusion setting. Are jail cells really the only secure option? Are not these cells actually designed with a minimum of external monitoring in mind? What effect does locking an acutely mentally ill person into a jail cell analogue have on that person? And last but not least, Should any adverse effect be dismissed as an acceptable consequence of behaviour management.
