Seclusion Debate: Ethical Considerations and Alternatives

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BORDERLINE PERSONALITY DISORDER
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Psychiatry and psychiatric management
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Assignment 1
Seclusion debate.
The management of patients with behaviors that are violent with psychiatric disorder brings
challenges when it comes to the respect of both the health care provider and the patient rights
and their safety. Seclusion and restraining of patients are among the most controversial
procedures in the psychiatric field. Internationally the use of seclusion, sedation, and restraints
are utilized so as to contain and regulate those high-risk patients with possible dangerous
behavior. Although, they are considered to be problem prone interventions which pose danger to
both the patient and the health care provider. The use of seclusion in managing patients who are
dangerous and violent has a conflicted and long history. Despite this, there have been reports on
its benefits and why it is considered (Huckshorn, 2016).
Seclusion is the involuntary confinement of patients in a room where they cannot leave for a
certain period. Seclusion is a type of restraint. It’s an environmental restraint. The seclusion is
being used in psychiatric wards to ensure that the patient does not harm themselves or harm
others. Although seclusion harms more than it benefits (Craig & Sander 2018).
The cons of using seclusion include (Meehan, T., Bergen, H., & Fjeldsoe, K. (2014): firstly, it
has been reported that the use of seclusion brings traumatic and harmful experiences in the
setting of the psychiatric wards. It has also been noted that it has previously been misused to
exert control and power. Secondly, it goes against the rights of the patient/service user. The
psychiatric patient has rights to be protected from harm, abuse, and unjustified medication. They
also need to be treated in environments that are less restrictive with least intrusive treatment
which should also be appropriate to their needs. the patient has the rights to receive treatment

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only for diagnostic/therapeutic purposes. They should never receive treatment for other
convenience or as a punishment. In addition, they should only be secluded if this is the only
mode of treatment available so as to cub imminent/immediate harm to self or others. the
treatment should also be directed towards enhancing and preserving the dignity and the
autonomy of the patient. Fourthly, for patients with comorbid drug use and alcohol use, the use
of seclusion predisposes them to self-harm/injuries. lastly, it has been associated with negative
psychological traumas as the patients. They feel ashamed, guilty and loss of self-respect, dignity,
and loss of autonomy. Lastly, the presence of alternatives instead of using seclusion. For
example, ensure there is an adequate number of nurses attending to the patient. this will ensure
that the patients get engaged in reducing their aggression. In addition, multi-professional
collaboration so as to ensure that the patient collaborates (Raveesh, Gowda & Gowda, 2019).
It is, therefore, clear that the seclusion of a psychiatric patient is unethical. It goes against
patients’ rights. There are numerous alternatives that can be used instead. It traumatizes the
patient’s psychological aspect. Lastly, it poses danger to those patients who use substances of
abuse. In seclusion, they are at risk of injuring themselves.

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Assignment 2: Assessment of risks in acute mental health presentation.
Part 1
Risk assessment in mental health.
Risk is the possibility of an adverse outcome or event. Risk factors are those specific features of
behavior, illness or a circumstance which when combined or alone they lead to increased risk.
Lastly, risk assessment is the estimation of the likelihood of a certain adverse event to occur
under certain circumstance within a given time (Hunter, Chantler, Kapur and Cooper, 2013). In
mental health, the risk assessment is usually used to assess the patient's risks of violence to
others although it is broader than this. It is categorized into; risk of progression of illness this is
the risk to the health of the individual. Secondly, the risk of inflicting self-harm intentionally this
includes suicide. Thirdly, the risk of harming self unintentionally. Lastly, the risk of
unintentional or intentional violence or behaviors that induce fear of others (WHO, 2014).
Examples of risks to self: risk to self which includes deliberate harm to self and suicidal acts.
The risk to health. This includes physical harm, alcohol and substance abuse and psychological
harm. Risk of the quality of life. This is in terms of their dignity, financial and social status. All
the former is at the risk of getting tarnished. The risk of being vulnerable which exposes them to
exploitation, violence from others and sexual abuse. The risk of self-neglect. Lastly risk of
cultural and spiritual (Steeg et al, 2018).
Examples of risks to others; risk of violence which includes, sexual, emotional and physical. The
risks of intimidating others or threatening others. the risk of neglecting their dependents or being
abusive to them. the risk of stalking or harassing others. the risk of damaging property. The risk

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of being a public nuisance. Lastly, the risk of exhibiting reckless behavior, for example, reckless
driving (Steeg et al, 2018).
The risk (s) tends to be fluctuating, they are not static. That is why it is important to assess the
risk status time after time. It is an on-going process. Risk assessment is an important part of
every clinical assessment/ observation.it should be done on the first encounter with the patient.
When there is a change or a transfer of care. When the legal status change. When there are life
changes for example loss of a significant other. When there is a mental state change that is
significant. Lastly, when discharging the patient or moving them to environments that are less
restrictive (Steeg et al, 2018).
Part 2
The risk assessment tools
Risk assessment tools should evaluate the patient's mental status, the environmental/current
factors, and historical information. On the mental status, the patient's behavior, affect, cognition
and perception should be assessed. On the environment, immediate stressors, access to harmful
agents, current situation and the individual's attitude should be assessed. On the historical
information; past illness and incidents should be assessed; their personality and family
background should be assessed (Chan, Bhatti, Meader, Stockton, & Evan, 2016).
The risk assessment tools include; comp RA (N. Ire) this is a risk screening tool a comprehensive
risk assessment and management tool in Northern Ireland. It has two steps process in which it
assesses the risk and guides on its management. secondly, the DICES system in which it
describes the patient's risks identifies the various options, chooses one's preferred solution,

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explains one's choice and shares ones thinking. Thirdly, Functional Analysis of care
environments (FACE) it mainly supports the risk domains that are assessed, encourages the
collaboration of patients and caregivers. Fourthly, Galatean Risk screening tool (GRIST), this
one provides a systemic and structured approach in risk assessment. Fifthly, Sainsbury Clinical
risk assessment tool. Sixthly, Skills-based training on risk management (STORM), this one
focuses on identifying the risks and coming up with solutions. Seven, standard tool for the
assessment of risk. Lastly, Weish Assembly Risk Research Network (WARRN) this is a
formulation-based assessment that requires the patients and the clinicians to work together
(Hunter, Chantler, Kapur, and Cooper, 2013).
A research conducted by the National Confidential Injury into suicide and homicide by people
with mental illness, (2017) on the assessment of clinical risk in mental services concluded the
following. Among all the risk assessment tools the service’s own tool, Rio risk screen, and
FACE were the most used while DICES, STAR, and STORM were the least used. In addition, it
was noted that a majority of these tools encouraged the staffs to be able to make future behavior
of the patient and to stratify the patients' risk status.
Despite this, there were gaps that were identified in the risk assessment tools as only 64% of the
tools that were assessed, assessed the family history of suicide. Secondly, 61% accessed the
patient’s recent and their lifetime contact with the health care providers at mental health clinics.
Thirdly, only 62% assessed history on abuse, protective factors, and physical illness. Fourthly,
only, 47% assessed the patients on their employment status, homelessness, living alone, and
family social network. Fifthly, only 31% assessed the psychosocial stressor, stress tolerance, the
domestic problems, the recent events in their lives, and their current victim (s) of abuse. Lastly,
on the substance use, 90% assessed on lifetime use of substance while 71% assessed on the