The Practice of Seclusion and Restrictive Practices in Mental Health Services

Running head: MENTAL HEALTH
Mental health
Name of the student:
Name of the University:
Author’s note

1MENTAL HEALTH
Restrictive practices such as seclusion and restraint are common intervention in mental
health to manage aggressive or violent consumers. However, due to the negative consequence of
this practice on staffs and consumers, there has been an international drive towards reducing or
completely eliminating the use of this practice in mental health (Muir‐Cochrane, O'Kane &
Oster, 2018). Various programs and efforts have been implemented globally to reduce the rate of
seclusion and restraint events for patient. However, the issue is that this practice has not yet been
curtailed off and restrictive practices continue to be a part of mental health care. Due to such
widespread support for eliminating this practice, it is paramount to understand the rationale for
this (Hext, Clark & Xyrichis, 2018). Thus, to develop knowledge in this area, the main aim of
this essay is to critically discuss about the practice of seclusion or restrictive practices in mental
health services and evaluate its impact on health care professionals and patient. The essay will
further discuss the role of registered nurse in collaborating with consumers to support work
towards State/territory initiative and National initiatives.
The use of restrictive intervention is debatable in mental health practice. However, it is
still used in Australian mental health settings just like other countries. Seclusion involves
confining a person alone in a room where contact with other individuals are prohibited, whereas
restraint involves restricting freedom of movement of a person by using physical or mechanical
means (Jackson, Baker & Berzins, 2019). Patient with mental illness and their carers in Australia
have advocated against this restrictive practice because of the infringement of human rights and
compromising the therapeutic relationship between staff and patient. The Australian Mental
Health Commission calls for leadership across range of priorities to address the issue. To track
reduction efforts, many health agencies and Committees in Australia has collaborated to record
data on seclusion, mechanical and physical restraint and track reduction in rate of restrictive

2MENTAL HEALTH
practices as part of quality improvement agendas (Australian Institute of Health and Welfare,
2020). The regulation of restrictive interventions is now legal under The Mental Health Act 2014
and the Victorian Government has shown commitment to reduce this restrictive interventions too
(Victoria State Government, 2020). There are several reasons for the National and State
government to take action on the issue and this is explained further in the next paragraph.
Both health consumers and staffs have poor attitude towards seclusion and restraint in
mental health. This has been seen from review of several research papers evaluating and beliefs
about the practices from consumers, carers and mental health care professionals. An online
survey done in Australia regarding interpreting views of consumers on seclusion and restraint
practices revealed that majority of participants had negative views about the process because of
its potential for causing harm to patient, breaching human right and compromising trust (Kinner
et al., 2017). The level of harm to patient through the use of seclusion is understood from review
of the experiences of these patients. A study by Ye et al. (2019) investigating about the impact of
restraint in mental health settings reported that patients going through physical restraint
experience have gone through severe psychological trauma. For example, they suffered from
feeling of low self-esteem, extreme distress and re-evoking of childhood sexual abuse triggers. In
the long term, these experiences have resulted in low quality of life and loss of hope for affected
individuals. These experiences in turn will further worsen the stigma and negative affect
adherence to medical treatment too. Thus, when weighing the benefits of the intervention
compared to cost, it has been found that seclusion is associated with more harm than benefits for
patient.
In addition to psychological trauma associated with restraint, another reason behind
disapproval of restrictive practices among consumers as well as staff is that it is associated with

3MENTAL HEALTH
violation of ethical principles of autonomy, justice, beneficence and non-maleficence (Campos &
Rezende de Oliveira, 2017). According to the ethical principle of patient autonomy, it is
necessary to support individuals to take their own decisions and staffs have the duty to respect
autonomy of patients. However, maintaining individual autonomy becomes difficult for nurse
and leads to ethical challenges for them. For example, when a nurse faces patients with
aggression, it is their responsibility to protect other patients by using seclusion. This action is for
public benefit, however as patient’s wish is not respected and this done against force, patient
autonomy is violated. As restrictive practices do not consider the unique need and perspective of
patient, it is also said to be in violation of patient-centred care (Zheng et al., 2019). Moreover,
the Universal Declaration of Human Rights emphasizes the need to promote equality and justice
for all. However, secluded patients have reported about not being able to receive equal nursing
service as other patients as they are treated badly and secluded in rooms with poor condition
(Haugom, Ruud & Hynnekleiv, 2019). Thus, review of these experiences show how restrictive
practices can rob patients from their inherent rights to be treated with equality, integrity and
dignity. The experience is associated not only with traumatic experience but also destruction of
patient’s relationship between patient and nurse. A post-seclusion review by Muir‐Cochrane,
Baird and McCann (2015) suggests that nurses or mental health staffs often regret or complain
regarding the negative impact of such practices on staff-patient relationship.
Many mental health consumers are in favour of removing seclusion and restraint
practices as they have suffered because of this too. The study by Haugom, Ruud and Hynnekleiv
(2019) has expressed that the need to use seclusion has been associated with extreme distress due
to decision making challenges for mental health professionals. They have expressed feeling
insecure while using this practice as many patients attack them during the process and they get