Use of Coercive Measures in Forensic Psychiatric Care

Running head: SECLUSION 1
Impacts of Seclusion to Consumers and Healthcare Professionals Alike
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SECLUSION 2
Introduction
The practice of seclusion in the mental health services has been in existence for decades,
but it has been critiqued by both the healthcare professionals and consumers. The mental health
sector is faced with multiple challenges because of the nature of patients that nurses there deal
with. Seclusion has been regarded as the most appropriate method of dealing with mental illness
patients because it enables nurses to control them easily. However, this method grossly violates
the rights of the patients and even causes mental anguish to nurses, hence the need to explore its
effects on patients and healthcare experts.
Impacts of seclusion to consumers
The historical application of physical restraints and seclusions in mental health services
has led to clinical and ethical debates surrounding the basics and misuse of physical restraints
(Chieze, Hurst, Kaiser, & Sentissi, 2019). As a result, both the patients and health care
professionals have adversely been affected. Trauma and retraumatization have been found as the
most common impact of seclusion to consumers. The act of physical restraint results in trauma in
some mental health patients because it brings back memories of previous hurtful experiences.
Restraint is also anti-recovery and instills fear among patients with mental illness and their
families (Goulet, & Larue, 2016). Brophy et al. (2016) examined the act of seclusion and
restraint from the patients’ perspective by assessing an Australian focus group. The participants
had in one or more times experiences seclusion and therefore recorded individual experiences.
The study found out that most of the participants attributed seclusion to traumatic experiences
which were in most cases resonated with the act of being forcefully secluded. Some of the
participants pointed to the poor living conditions such as lack of toilet and fresh air as the major
cause of trauma.

SECLUSION 3
Blunt trauma to the chest is another significant risk of seclusion. For instance, the legal
case by Estévez-Guerra et al. (2017) found out that a teenager sustained a chest blow in the
process of forced seclusion and succumbed. The autopsy did not show any findings but it was
attributed to a cardiac arrhythmia which is a less serious condition of myocardial concussion
leading to a blunt trauma to the chest which causes death. Thus, sudden death which is
attributable to blunt trauma to the chest but with no morphological variations in the myocardium
can only be attributed to the short-time sequence of events.
An evaluation of the adverse effects of seclusion was carried out by Bellenger, Ibrahim,
Bugeja, and Kennedy (2017). The study consisted of a qualitative review of scientific databases.
The authors found out that the practice of seclusion exposed the patients to death and injury.
Furthermore, seclusion can be traumatizing even if it does not necessarily lead to death and
injury (Soininen, Kontio, Joffe, & Putkonen, 2016). The investigative report by Mellow, Tickle,
and Rennoldson (2017) showed that over 20% of the reported deaths in mental health facilities
could directly or indirectly be attributed to forceful seclusion. Seclusion can also lead to death
by aspiration. The research by Flammer, and Steinert (2015) posits that during the process of
restraining patients while at the prone position makes them vulnerable to suffocation whereas the
supine position exposes them to aspiration. Low conscious levels cause aspiration and patients
might become immobile when their airway is interfered with.
Another significant impact of seclusion is dehumanization which is majorly caused by the
experiences gained during the process. Mellow et al. (2017) found out that elderly mental health
patients were left in clothes soaked in urine which also made them feel insignificant and hence
the reason for their seclusion. Other participants also were of the view that the staff were too
arrogant and used much force during seclusion. Additionally, some mental health patients

SECLUSION 4
believed that the healthcare experts were punishing them and exercising their authority on them
leading to thoughts of insignificance, weak and low self-esteem. As a result, the effect of
dehumanization also affects the healing process of the mental health patients, hence the reason
why it is believed that seclusion counters the very objective it is meant to achieve.
The practice of seclusion flouts the principle of autonomy which requires the patient’s
informed consent before any action relating to the patient is pursued (Zheng et al., 2020). It is
required in nursing practice that the decision of the patients is consulted in making decisions
even in the event of deficiency in mental health. However, in most cases, mental health patients
are aggressive thus making it difficult for nurses to seek their view of seclusion. This makes
them feel that their freedom and ethical values have been violated.
Multiple studies have consistently attributed seclusion at mental health facilities to the
increase in depression among the patients. The act of social isolation creates a gap between the
patient and loved ones and leads to loneliness and depression sets in. Therefore, as much as the
healthcare experts are providing a solution of safety to the family and staff, they are also creating
another problem of mental health of the patient that is already sick and in need of urgent medical
attention (Brophy et al., 2016).
Impacts of seclusion to healthcare professionals
Seclusion is often thought that it only affects the patients, however, healthcare
professionals are also affected while implementing existing policies on mental healthcare
practices. The healthcare experts face the risk of injury and even death while enforcing seclusion
in mental health facilities because in most cases the patients are aggressive and are likely to
cause harm to the nurses during the process. On the other hand, seclusion can be traumatic to the

SECLUSION 5
nurses in mental health settings especially when it is associated with physical force. Nurses are
equally traumatized by the ordeal because they are humans as well. Haugom, Ruud, and
Hynnekleiv (2019) conducted a study on the experiences of the healthcare experts in the
provision of seclusion services to mental health patients. The researchers found out that the
practice of seclusion caused mental anguish on the staff. Some of the participants noted that they
became physically and mentally exhausted especially when there was required a follow-up with
the patient in his/her room.
It has also been observed that most of the mental healthcare professionals are active in
drug and substance abuse more than the general population. Research has associated this
behavior with the nature of experiences that they undergo. For instance, Cares, Pace, Denious,
and Crane (2015) examined the prevalence of drug and substance abuse among mental
healthcare experts. 25% of the nurses consumed the drugs at the workplace based on how
stressful the impending work was. This affected their efficiency at work and thus risking their
carrier due to the stressful work such as forceful seclusion and restraint.
The nurses are ethically affected by the act of seclusion in an attempt to strike a balance
between the patient’s rights and the safety of the staff. Most of the patients with mental illness
are aggressive towards nurses when being secluded. However, it is expected that nurses should
respect their individual freedom or at least obtain an informed consent before seclusion.
Furthermore, the recent emphasis on the provision of patient-centered care becomes a challenge
to healthcare professionals who have to ensure her/his own safety, of other patients and staff.
Therefore, such a situation forces the nurse to violate the basic principles of nursing practice
during seclusion. Zheng et al. (2020) discussed the ethical issues associated with seclusion in

SECLUSION 6
mental health services. The outcome indicated that seclusion violated the basic ethical principles
on both the mental illness patient and on the nurses as well.
Role of The Registered Nurse in Collaborating With Consumers To Work Towards
State/Territory and National initiatives in Reducing Seclusion And Restraint
Registered nurses have critical roles in collaborating with consumers to work towards
state/national initiatives to reduce seclusion and restraint. Nurses can cooperate with consumers
to play a significant role in reducing or eliminating restraint and seclusion through advocacy.
Both of them can exert pressure on both the local and national governments to address seclusion
and restraint. This can be accomplished through public opinions, incorporation of the state and
other stakeholders in the planning and implementation of advocacy programs. The advocacy
approach is much more successful if initiated by the registered nurses and supported by the
patients with seclusion experiences compared to when it is only one party that is advocating for
change (Blair et al., 2017).
The nursing leadership in collaboration with the patients or their families can as well
work towards government initiatives in reducing seclusion and restraint through organizational
leadership and oversight. There is substantial evidence of the literature that posits that vibrant
and devoted leadership is important in any of the processes to eliminate restraint and seclusion.
When dealing with mental health services and consumers, healthcare experts take the leadership
role and thus they must own the vision and the action plan and then be followed by the patients
or their families. Nurses have the role of championing for the elimination of seclusion in a clear
priority, incorporate the consumers and their families in the process. They can also accomplish
this by using a language that is inclined to recovery issues and by awarding nurses and
consumers that embrace change (Jayaram, 2016).

SECLUSION 7
Registered nurses can also help in the reduction of seclusion and restraint through
organizational culture. As leaders in the health sector, nurses significantly inspire organizational
culture. Research has shown that change in organizational culture is fundamental for reducing
seclusion. This is because the use of force and sometimes violence is more often a culture that is
engrained in an organization and practiced by the staff. Therefore, to change the attitude and
operations of the staff, it is important to first change the organizational culture and then
consumer attitudes will change automatically (National Mental Health Commission, 2015)
Registered nurses and consumers can also collaborate and work towards territory/national
initiatives of reducing seclusion and restraint by offering free education and training to
consumers on the disadvantages of seclusion and how their participation is important for change.
Khalifeh (2015) observed that the development of service user skills is significant in reducing
seclusion. The nurses can play this role by promoting independence, offering options and
assisting the consumers with behavior regulation plans. For example, the Louisiana facility
mental facility established a rehabilitation center in which the users are taught communication
skills, management of anger and confidence (Riahi, Dawe, Stuckey, & Klassen, 2016).
Another approach that nurses can help to reduce seclusion is by obtaining feedback from
the services offered. Then any service with positive feedback is adopted and encouraged (Oster,
Gerace, Thomson, & Muir-Cochrane, 2016). Debriefing is another collaborative role between
nurses and consumers that can help reduce seclusion and restraint. Debriefing requires the
acknowledgment of feelings and the presentation of facts which also acts as a learning
opportunity and the avoidance of similar cases in the future. Debriefing also helps reduce the
negative effects of seclusion and address corporate issues through change (Oster et al., 2016)
Conclusion

SECLUSION 8
Seclusion in mental healthcare service has been practiced for several years, however,
with the advancement in human rights activism and more emphasis on patient-centered care, this
practice has widely been criticized. The criticism has been based on its impact on consumers and
healthcare experts. It is responsible for most cases of trauma in mental health and even
depression. The complications associated with seclusion can even lead to death among
consumers. Registered nurses are equally affected by seclusion as much as they implement it.
They find themselves in an intricate position where they should exercise patient-centered
services and respect the rights of mentally ill patients. At the same time, they need to protect
themselves and others from the aggressive patients. However, they play a critical role in reducing
seclusion and restraint, and therefore should advocate for change in collaboration with the users.

SECLUSION 9
References
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