NRSG263: Impact of Seclusion and Restraint on Mental Health Consumers

This essay examines the controversial practices of seclusion and restraint within mental health services. It begins by defining these practices and highlighting the ethical concerns raised by patients, families, and medical professionals. The essay explores the positive and negative impacts of seclusion and restraint, emphasizing the negative experiences and the resulting efforts to eliminate these practices. It references the Mental Health Act 2014, which mandates the use of seclusion and restraint as a last resort. The essay further discusses ethical principles guiding mental health nursing, including justice, autonomy, beneficence, and non-maleficence. It evaluates the effects of seclusion on both consumers and medical professionals, citing research on patient perceptions and the infringement of human rights. The role of consumers, national initiatives, and registered nurses in reducing the use of seclusion and restraint is then analyzed. The essay concludes by emphasizing the importance of alternative approaches and the need for adherence to ethical standards to protect the safety and rights of mental health consumers.

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Name
Institution of Affiliation

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Abstract
Seclusion and restraint are common practices that are applied when providing mental
health services. Seclusion is an invasive practice that prevents the free movement of a patient
who is enclosed in a room while restraint is the prevention of free movement of an individual,
this is applied through either physical, mechanical or chemical strategies. These practices
have raised several concerns among the patients, their families and medical professionals
who want the elimination of these practices. seclusion and restraint have both raised ethical
concerns and have been viewed as infringing the rights of the consumers seeking mental
health services. There are several effects of these practices both positive and negative.
However, the negative experiences of these practices outweigh the positive ones and as a
result, several measures have been taken by the government, services providers and
consumers to abolish these practices. According to the Mental health act, 2014 seclusion and
restraint should be used as last resort options in providing mental health treatments. Other
alternative measures to restraint and seclusion should be applied to protect the safety and
rights of the consumers.

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Introduction
Mental health is the state of emotional, physiological and social welfare, it is the
absence of mental illness. Mental illness is a health condition that severely impairs how an
individual feel, thinks, behaves and interacts with other people. It is characterized by several
symptoms such as hallucinations, delusions, irrational behaviour, extreme changes in mood
and reduced ability to concentrate. Mental illness leads to a mentally disordered individual
and treatment should be provided to protect the person from causing harm to themselves and
others. Mental health is very crucial in the course of life as it directs how a person thinks,
handles stress and interacts with others. Several practices are used in providing mental health
services and these include seclusions and restraint.
Seclusion is the state of confinement of an individual in a certain area and any kind of
free exit is prevented. Restraint is when free movement of an individual is prevented means
such as mechanical, chemical and physical. These two phenomena are applied in mental
health treatment where acute services are provided. There are three types of restraint
including physical restraint which prevents movement of an individual by physical means
such as handcuffs and straps (CARR, 2012). Chemical restrain uses medication such as
sedatives which is aimed at controlling the person's behaviour rather than acting as treatment.
Emotional restraint is applied in conditions whereby an individual is unable to express their
thoughts to the medical staff due to fear of the resulting consequences (Kuosmanen,
Makkonen, Lehtila & Salminen, 2015).
In this criterion, the medics may be coercive and use threats so that the individual can
speak up. These practices are currently advocated to be used in such cases when providing
mental health services. There has been a movement to abolish these restrictive and seclusion
practices in the mental health services with claims that they are against human rights and

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destroy the relationship between patients and the medical professionals (Oster, Gerace,
Thomson & Muir-Cochrane, 2016). This move has been supported by the Royal Australian
and New Zealand College of psychiatrists which requires that seclusion and restrain should
be an intervention used as a last resort.
The National Mental Health Commission in Australia also advocate the use of these
practices in cases where the patient is not ready to submit to the treatment (Wyder et al.,
2017). These practices have led to post-trauma experiences in the induvial who receives the
treatment and several measures have been put in place in the medical profession to promote
recovery-focused services in the patients without causing harm. The National Mental Health
Consumer and Carer Forum are mandated with the role of ensuring that the rights both the
carers and consumers are respected. It has therefore been on the frontline to ensure that
seclusion and restraint practices in mental health services in Australia are eradicated. This
essay will, therefore, evaluate the impact of seclusion to carers and consumers as well as the
role played by registered nurses and consumers in eliminating these practices. It will also
describe the ethical principle that should be observed by nurses when providing mental health
services.
Ethical framework in mental health
Mental Health Australia is a non-governmental organization that nationally
champions and promotes the welfare of the Australian mental health sector thereby ensuring
better mental health for all the citizens. Mental Health Australia code of conduct has laid
upon ethical principles, standards and responsibilities that direct the decision making and
work performance of the members of groups in practice. These members include all the
employees, managers and any individual who undertakes duties representing Mental Health

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Australia. The ethical principles that guide the nursing practice in mental health treatment are
justice, autonomy, beneficence and non-maleficence (Cusack, Killoury & Nugent, 2016).
Justice requires the nurses to be exhibit equality, fairness and non-discrimination
towards the patients with mental health conditions they take care of. Beneficence is the act of
doing good and the right thing to the patients. Nurses are required to take actions that support
and benefit their patients. Non-maleficence is the obligation of doing no harm to the patients.
Nurses are required to ensure that their actions do not harm or risk the welfare of their
patients. Harm may be intentional or unintentional and intentional harm is objectionable and
should be avoided at all cost. Autonomy gives the patients the right to independence, freedom
and self-determination while making decisions. Patients are obligated to take responsibilities
for the decisions they make. Autonomy requires the nurses to respect the right of the patients
to make decisions without any coercion or judgments from the nurse. The patient is at liberty
to either accept or turn down any treatment (Oates, 2017).
Effects of Seclusion to medical professionals and consumers.
Use of seclusion in providing mental health services has several impacts on the
consumers and medical professionals. Based on online research carried out by the National
Mental Health Consumers and Carers forum in Australia different individual had various
perceptions of the benefits and harmful effects of this practice (Kinner et al., 2016). The
recognized benefits of this practice include the provision of safety to both the patient and
community at large. Most individuals in this survey endorsed the use of seclusion as a way of
increasing the safety of the patient and others because it controls the wild and violent
behaviour of the patient. Seclusion is also important to the medical professionals it helps
them to settle the patients and therefore preventing violent behaviour to self and others.

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Furthermore, some patients consider seclusion helpful in providing them with time and peace
to reflect on their emotions and thoughts.
The research also identified several dangers associated with the application of this
practice while providing mental health services. There is a strong agreement that seclusion
tortures the consumer and the carer both physically and emotionally and therefore does not
provide any therapeutic value (Happell & Koehn, 2011). It is reported that patients who
undergo seclusion report negative feedback of the practice. These patients are reported to
feeling punished, lonely, upset, vulnerable, trapped and abandoned. The use of seclusion is
believed to infringe human rights and as a result, it ruins the relationship and trust between
the consumer and carer (Brophy, Roper, Hamilton, Tellez & McSherry, 2016). Most of the
consumers regard seclusion practice as emotionally unsafe and traumatizing therefore it is
regarded to cause more harm than good to the patient. Furthermore, no evidence supports the
use of seclusion and restraint in providing quality mental health services (Campbell, Massey,
Broadbent & Clarke, 2018).
Role of consumers, national initiatives and registered nurses in reducing
seclusion and constraint.
There has been a decline in the use of seclusion and restrain practices in the mental
health services in Australia. In 2013 the Seclusion and Restraint Declaration was set up to
promote the decline of seclusion and restraint practices, by encouraging consumers to sign
the declaration. Subsequently, a survey was conducted by this organization and a thousand
responses were collected from consumers, their families, carers and supporters. This survey
was aimed at advancing and developing policies in regards to the elimination of these
practices.

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Several roles can be played by both the consumers and registered nurses to eliminate
seclusion and restraint. For example, nurses should adhere to the standards and ethics put in
place by their profession. The Australian Competency Standards outlines that a registered
nurse should carry out a personal and holistic evaluation to the patient and a nursing care plan
should be established. The patient should be actively participating in the implementation and
evaluation of this plan (Andersen, Kolmos, Andersen, Sippel & Stenager, 2017). This would
then lead to the abolishment of the involuntary restrain and seclusion practices in mental
health services. Therefore, the continuous use of these practices will result from the failure of
the registered nurses in practising the set standards for care in their profession. According to
the National Mental Health Consumer and Carer Forum elimination of these practices will
only be successful if the necessary standards set by the Australia Competency Standards of
registered nurses are implemented.
Based on the Mental Health Act 2014 seclusion and restrain should only be practised
as a last resort option. It is suggested that before considering seclusion the nurses should first
consider verbal de-escalation that involves engaging the patient before seclusion. Verbal de-
escalation helps in minimizing the seclusion and restraint practices as it builds a therapeutic
relationship between the carer and patient. It also helps to sets the behavioural boundaries of
the patient, instils self-control and eliminates the feelings of hate and possible violence in the
patient (Goulet, Larue & Dumais, 2017). Nurses, therefore, have a role to first talk to the
patients when offering mental services before considering seclusion practice this will help to
minimize these coercive practices (Gerace & Muir-Cochrane, 2018).
Consumers are also required to give informed consent before agreeing to undergo
mental health treatment (McSherry & Waddington, 2017). This informed consent should
include knowledge of the treatments that shall be used to reduce distress and trauma. The
nurses are required to tailor the treatment provided to fit the needs of the consumer

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(Hawsawi, Power, Zugai & Jackson, 2020). The consumers should be actively involved in the
formulation of this plan which will safeguard the wish of the patients in the use of other
alternative practices to seclusion and restraint in managing distress and aggression.
Therefore, consumers and carers have a role in formulating plans that will provide mental
health services while minimizing the use of seclusion and restraint practices. These strategies
should be developed when the consumer is well to avoid practices of seclusion and restraint
against the patient's will.
The National Mental Health Consumer and Carer Forum regard the healthcare
professional as the basis of eliminating seclusion and restraint in providing mental health
services. It states that medical professionals have a role in accepting the provision of
education in their line of duty that will enable inputting the necessary measures to adhere to
the standards in mental health. The consumers and carers have a role in supporting the
implementation of frequent audits regarding the experience of seclusion and restraint
practices. These audits will enable the improvement in the quality of service provided as well
as devising new strategies that will reduce distress in the carers and consumers.
Additionally, medical professionals have a role to ensure that thorough examination is
carried out on any person that is secluded before any approval to continue with the restrain
and seclusion (Muir-Cochrane, 2018). In case a decision to apply these practices is approved
then the type of restraint and period of seclusion should be minimum to ensure safety and
rights of the consumer are safeguarded. The period of seclusion should be minimum to enable
the application of other alternative approaches to seclusion and constraint.
Conclusion
In conclusion restraint and seclusion have been found tom have several negative
effects on the consumer as well as the carer. Seclusion and restraint should, therefore, be

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implemented as options of the last resort when all the alternative practices have proven futile
(Fletcher et al., 2018). It is recommended that early intervention and prevention strategies
should be put in place to reduce the use of these practices. one of these strategies is verbal de-
escalation which has proven to be therapeutic, efficient and crucial in reducing the use of
these practices. in cases where restraint and seclusion have to be used the healthcare
professionals are required to follow all the regulations given by the state to ensure the safety
of the consumer (Fisher, 2013). To achieve the abolishment of these practices, the National
Mental Health Consumer and Carer Forum has advocated the distribution of achievements of
the National Seclusion and Restraint project to all the relevant stakeholders to aid in the
elimination of these practices.

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References
Andersen, C., Kolmos, A., Andersen, K., Sippel, V., & Stenager, E. (2017). Applying sensory
modulation to mental health inpatient care to reduce seclusion and restraint: a case
control study. Nordic Journal Of Psychiatry, 71(7), 525-528.
Brophy, L., Roper, C., Hamilton, B., Tellez, J., & McSherry, B. (2016). Consumers and their
supporters’ perspectives on poor practice and the use of seclusion and restraint in
mental health settings: results from Australian focus groups. International Journal Of
Mental Health Systems, 10(1).
Campbell, K., Massey, D., Broadbent, M., & Clarke, K. (2018). Factors influencing clinical decision
making used by mental health nurses to provide provisional diagnosis: A scoping
review. International Journal Of Mental Health Nursing, 28(2), 407-424.
CARR, P. (2012). The use of mechanical restraint in mental health: a catalyst for change?. Journal
Of Psychiatric And Mental Health Nursing, 19(7), 657-664.
Cusack, E., Killoury, F., & Nugent, L. (2016). The professional psychiatric/mental health
nurse: skills, competencies and supports required to adopt recovery-orientated policy
in practice. Journal Of Psychiatric And Mental Health Nursing, 24(2-3), 93-104.
Fisher, J. (2013). The use of psychological therapies by mental health nurses in Australia. Journal Of
Psychiatric And Mental Health Nursing, 21(3), 264-270.
Fletcher, J., Hamilton, B., Kinner, S., Sutherland, G., King, K., & Tellez, J. et al. (2018). Working
towards least restrictive environments in acute mental health wards in the context of locked
door policy and practice. International Journal Of Mental Health Nursing, 28(2), 538-550

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Gerace, A., & Muir-Cochrane, E. (2018). Perceptions of nurses working with psychiatric consumers
regarding the elimination of seclusion and restraint in psychiatric inpatient settings and
emergency departments: An Australian survey. International Journal Of Mental Health
Nursing, 28(1), 209-225.
Goulet, M., Larue, C., & Dumais, A. (2017). Evaluation of seclusion and restraint reduction
programs in mental health: A systematic review. Aggression And Violent
Behavior, 34, 139-146.
Happell, B., & Koehn, S. (2011). Impacts of Seclusion and the Seclusion Room: Exploring the
Perceptions of Mental Health Nurses in Australia. Archives Of Psychiatric Nursing, 25(2),
109-119.
Hawsawi, T., Power, T., Zugai, J., & Jackson, D. (2020). Nurses' and consumers' shared experiences
of seclusion and restraint: A qualitative literature review. International Journal Of Mental
Health Nursing.
Kinner, S., Harvey, C., Hamilton, B., Brophy, L., Roper, C., McSherry, B., & Young, J. (2016).
Attitudes towards seclusion and restraint in mental health settings: findings from a large,
community-based survey of consumers, carers and mental health
professionals. Epidemiology And Psychiatric Sciences, 26(5), 535-544
Kuosmanen, L., Makkonen, P., Lehtila, H., & Salminen, H. (2015). Seclusion experienced by mental
health professionals. Journal Of Psychiatric And Mental Health Nursing, 22(5), 333-336.
McSherry, B., & Waddington, L. (2017). Treat with care: the right to informed consent for
medical treatment of persons with mental impairments in Australia. Australian
Journal Of Human Rights, 23(1), 109-129.

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Muir-Cochrane, E. (2018). Using restraint with restraint: A reflection. International Journal Of
Mental Health Nursing, 27(3), 925-927.
Oates, J. (2017). Editorial: Being a mental health nurse. Journal Of Psychiatric And Mental
Health Nursing, 24(7), 469-470.
Oster, C., Gerace, A., Thomson, D., & Muir-Cochrane, E. (2016). Seclusion and restraint use in adult
inpatient mental health care: An Australian perspective. Collegian, 23(2), 183-190.
Wyder, M., Ehrlich, C., Crompton, D., McArthur, L., Delaforce, C., & Dziopa, F. et al. (2017).
Nurses experiences of delivering care in acute inpatient mental health settings: A narrative
synthesis of the literature. International Journal Of Mental Health Nursing, 26(6), 527-540.
.

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