Seclusion's Impact: Patients, Professionals, and Registered Nurses

This essay investigates the profound impact of seclusion and restraint on individuals with mental health conditions and the healthcare professionals who provide their care. It explores the negative effects of seclusion, including the development of post-traumatic stress symptoms, feelings of dehumanization, and potential for physical and psychological harm, while also examining the challenges faced by nurses in mental health settings, such as social stigma and staffing shortages. The essay highlights the role of registered nurses in mitigating the adverse effects of seclusion by adhering to guidelines like the Mental Health Act 2007, promoting patient rights, and ensuring the responsible use of psychotropic medications. The discussion emphasizes the importance of alternative treatment options and the need for a supportive environment to improve patient outcomes and reduce the reliance on restrictive practices. Furthermore, the essay stresses the need for nurses to be aware of the side effects of psychotropic drugs.

Running head: IMPACT OF SECLUSION
IMPACT OF SECLUSION
Name of the Student
Name of the University
Author Note

IMPACT OF SECLUSION
INTRODUCTION
Restraint and seclusion are conditions to which individuals are subjected as the last
option to treat severe behavioural or mental issues. Seclusion can be defined in terms of
mental health as the restraint in which an individual is locked down inside a room or
antipsychotic drug can be given to control behaviour (Canadian Patient Safety Institute,
2020). They are also prescribed to consume various psychotropic medications to improve the
patient condition such as depression, anxiety, schizophrenia and bipolar disorders (Brett et
al., 2017). These medicines are prescribed according to the signs and symptoms an
individual. The drugs function by creating alterations in the neurotransmitters (Rao &
Andrade, 2016). This essay will shed light on the impact of seclusion on patients and
healthcare professionals and the role of registered nurses in reducing seclusion and restraint.
DISCUSSION
IMPACT OF SECLUSION ON PATIENTS AND HEALTHCARE
PROFESSIONALS
Seclusion and Chemical Restraints of patients with severe mental diseases impacts a
huge negative effects on the patient health and mental status. A review study discussed the
impacts of seclusion on patients in which the authors reviewed about 35 articles on this very
topic. The authors showed that about 25% to 47% of individuals after being subjected to
seclusion developed post-traumatic stress symptoms and had a deleterious mental and
physical effect. The study provides quite a few information, which were not conclusively
discussed before and thus, would help design further policies to make the healthcare system
more careful about the patient situation and their actions (Chieze et al., 2019).

IMPACT OF SECLUSION
Another study was conducted that consisted of consumers of the mental health
services and their supporters in Australia. This study concluded by the statement that all the
participants of the study mentioned about violation of human rights, traumatic experience,
isolation and dehumanization (Colaizzi, 2016). They also reported that the behavior they used
was excessively forceful; the workers had no empathy towards them and had no way of
communicating anything to anyone. Thus, the study also showed the mentality and the
negative behavior the patients’ have developed during seclusion and restraint towards mental
health care in Australia (Askew, Fisher & Beazley, 2019). Various researchers also conclude
that seclusive and restraintful treatment is unnecessarily overused and also affected numerous
patients and also ended in fatal outcomes (Brophy et al., 2016).
Researchers also question the Australian Health Policies, criticizing the goals and
vision the system has towards seclusion as a way of treatment. The World Health
Organization stated that seclusion and restraint are not any appropriate therapeutic techniques
that can be used to treat with mental issues and might exert unfavorable effects on the
individual (World Health Organization, 2017). It has been observed that seclusion and
restraint increase the tendency of both the patients and the health workers towards physical
and psychological harms and in severe cases it has often claimed lives in both Australia and
internationally (World Health Organization, 2017). This statement by the World Health
Organization made the whole medical system seriously consider the situation and therefore
the Australian government also acted promptly on the situation and made some changes in
their guideline (Bullock et al., 2014).
Another literature also reported that the health care professionals often have the belief
that seclusion and restraint helps in curing the patient and beneficial for them as well. The
doctors and health workers over time have tried justifying the usefulness of seclusion and
restraint in treating the patients and for achieving positive outcomes. The health care workers

IMPACT OF SECLUSION
also had a view that if the seclusion and restraint is reduced the safety of both the patients and
themselves would be at stake. Adding to this the patients often behave violently and suicidal
which might lead them towards hurting anyone or committing suicide. These all justifications
by the health workers and doctors are mostly absent from the evidences in the cases treated in
this procedure, and show the exact opposite version of this. However, the patients reported of
an extreme harsh experience during the seclutive period. The most common feeling among
the consumers in this case included anger, loneliness, upset, more depressed, vulnerable,
abandoned, trapped and punished. The consumers also complaint of merciless behavior they
faced from the workers that included beating and forceful medication (Lloyd, King &
Machingura, 2014). Thus, the paper again conclusively showed that the feeling of the patients
towards the seclusion system is all the same and the other medical case evidences also report
likewise. Other studies also hint towards similar derogatory effect that seclusion exerts on
individuals with severe mental health issues (Read et al., 2014).
For example, it was seen in various interviews conducted in Australia on the patients
who had mental illness issues that they faced inhuman torture from health care professionals
while staying in seclusion ward of hospitals. The patients also reported of the trauma of being
alone all the time and having nobody to converse with. The frequent beating and torture in
cover of treatment was also evident from their statements (Lea et al., 2018). Furthermore,
there are also innumerable instances found in which the patients after being discharged from
seclusion wards developed post-traumatic stress disorder (PTSD), which further caused
decline in their state of well being (Phipps, Molloy & Visentin, 2019). Moreover, cases were
also found in Australia in which seclusion have caused death of patients (Ross, 2018).
Thus, the use of seclusion and restraint should only be prescribed to a patient when
there are no other options left. The guideline system of this treatment should also be based on
the principles that include ensuring safety and wellbeing of the admitted patient as well as the

IMPACT OF SECLUSION
staffs, the patients are subjected to this process of treatment for the minimum period of time,
the restraints that are applied should be less restrictive to ensure patient safety and most
importantly the actions that would be taken on the patient should be justifiable according to
the condition of the patient and according to the health policy guidelines (Wright, 2017).
The impact of seclusion and restraint is huge on others who have witnessed any of
these cases or heard from any consumer. They might think it as a way of punishment and
torture for the disease they are suffering from. Therefore, it has become an increasingly
essential thing to clear the concerns of these people so that they can take the treatment. The
individuals who are still skeptical about the treatment procedure might be prescribed for
counseling, and if the condition does not show any improvement, then they can be transferred
to a seclusion ward after letting them know about the actual reason and the improved scenario
of the treatment. Therefore, a proper explanation should be given to the individuals, which
includes ensuring them that they are not subjected to any kind of punishment, the changes
that are brought to the system of treatment and the consequences under which they would be
released (Sung et al., 2018).
The nurses also face a few challenges while working in a mental care facility ward.
More than actual challenges the main issue with the nurses are social stigma which has put a
permanent image in their brain and their misconceptions are the ones which need proper
addressing while educating themselves. The other challenges, which are prevalent in
Australia, are long shifts, which brings in irritation, insufficient pay scale, shortage in the
number of health care workers in mental health wards end up exerting immense pressure on
them and deinstitutionalization of mental health care facilities (Brijnath et al., 2014). Though
it is not justifiable completely, however these challenges often lead to their increased
frustrations and make them harsh or violent towards the admitted patients (Muskett, 2014).

IMPACT OF SECLUSION
Thus, it becomes one of the important things for the government to look after the problems
the nurses are facing to facilitate the provision of quality care.
The patients in seclusion and restraints are often prescribed to consume various
psychotropic drugs according to the condition they are suffering from. These drugs should be
prescribed at the correct dosage as wrong dosage can cause adverse effects on the patients
(Shaddel et al., 2015). This group of drugs have over the decade showed some of its benefits.
However, psychotropic drugs have been a topic for controversy since a long time because of
the side effects it exerts on the individuals consuming it. The normal side effects that
psychotropic drugs have on an individual include vomiting, weight loss or gain, diarrhea,
sexual issues, headache, fatigue and difficulty in sleeping or staying asleep. The adverse side
effects which are also observed in some cases include continuous drowsiness, thoughts and
attempts of suicide, depression getting worsened, panic attacks, dangerous impulses,
disturbing and morbid thoughts, memory loss, increased salivation and loss in vision
(Procyshyn, Bezchlibnyk-Butler & Jeffries, 2019). The instances of patients on psychotropic
drugs facing these issues have become very common in the last decade. As already
mentioned above there has been an increase in the consumption and usage of psychotic drugs
in Australia as well as in other countries, it is exerting a serious and severe effect on the
subpopulation. There are also a few recorded cases that stated numerous people on
psychotropic drugs have got their condition increased in spite of decreasing and cases of
deaths are also very common (National Institute of Mental Health, 2020). Thus, it is very
necessary for the doctors and nurses to have proper knowledge of the drugs and the dosage
before prescribing it to patients.

IMPACT OF SECLUSION
THE ROLE OF THE REGISTERED NURSE IN REDUCING SECLUSION
AND RESTRAINT
The role of registered nurses is humongous in maintaining the rules and regulations
set by the Australian government to reduce the impact of seclusion and restraint that used to
have on the patients previously. To avoid these scenarios of adverse effect the Mental Health
Act 2007, have designed a set of guidelines that needs to be followed carefully by the
registered nurses and health carers alike. The guidelines are as follows: the registered nurses
should provide optimum care to the patients who are suffering from any mental issues and the
environment of treatment should be the least restrictive and on the joyful side to facilitate the
effectivity of the treatment. Individuals admitted with mental disorder should receive high
quality care according to the optimum standards maintaining the time. The care should be
provided in such a way that the patients can work and participate in family and community
activities. The doctors should prescribe medications according to the standard of the patients
need for therapy and not according to the convenience of anyone. The individuals with
mental disorder coming for treating their condition should be enlightened about their
condition, its treatment, alternative treatment and the way they can get cured of the condition
in detail so that they gain interest and work towards their recovery from the conditions they
are suffering. The interference on the patients’ human rights, self respect, liberty and dignity
should be kept to a minimum level as possible apart from necessary conditions. The special
needs of the patients’ should also be acknowledged by the registered nurse according to their
age, sex, culture, religion and disability. The registered nurses should make serious efforts to
get consent from the patient about the mode of their treatment and the recovery plan designed
for them. Patients’ with mental illness who visit the healthcare facility for availing treatment
should be enlightened about their rights in the language or mode of communication they are

IMPACT OF SECLUSION
comfortable in. These are the guidelines to be followed while providing care to the patients
and thus, optimum patient care will be ensured as well (NSW Mental Health Act, 2020).
Seclusion and restraint should be only applied after the checking of the condition by
residing medical officer and the treatment can not lead towards violence on the patient. The
safety of the patients admitted in the hospital, nurses working in the hospital and the other
workers of the hospital is of prime importance to the residing medical officer. If any case of
violence arises in the hospital premise that might hamper the safety of patients and health
workers alike the medical office holds the authority of taking necessary steps. The medical
officer should also have the capability of managing severe aggressive situations. The penalty
that the medical officer can impose on the accused include 50 penalty units or six months of
imprisonment and in extreme cases both penalties can be applied against the accused
(Purpora, Blegen & Stotts, 2015). Thus, it is very important for the presence of stringent rules
to avoid any form of violence that might affect the patients as well as the nurses.
CONCLUSION
Thus, it can be concluded that the way seclusion and restraint was used in the last
decade should be immediately changed in all the hospitals and the new guidelines set by the
government should be followed minutely for providing optimum treatment and get a more
recovery rate. The use of psychotropic drugs should also be monitored across Australia and
newer alternatives should be chalked out to avoid the derogatory effects of these drugs.

IMPACT OF SECLUSION
REFERENCES
Askew, L., Fisher, P., & Beazley, P. (2019). What are adult psychiatric inpatients' experience
of seclusion: A systematic review of qualitative studies. Journal of psychiatric and
mental health nursing, 26(7-8), 274-285.
Brett, J., Karanges, E. A., Daniels, B., Buckley, N. A., Schneider, C., Nassir, A. & Pearson,
S. A. (2017). Psychotropic medication use in Australia, 2007 to 2015: Changes in
annual incidence, prevalence and treatment exposure. Australian & New Zealand
Journal of Psychiatry, 51(10), 990-999.
Brijnath, B., Mazza, D., Singh, N., Kosny, A., Ruseckaite, R., & Collie, A. (2014). Mental
health claims management and return to work: qualitative insights from Melbourne,
Australia. Journal of occupational rehabilitation, 24(4), 766-776.
Brophy, L. M., Roper, C. E., Hamilton, B. E., Tellez, J. J., & McSherry, B. M. (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), 6.
Bullock, R., McKenna, B., Kelly, T., Furness, T., & Tacey, M. (2014). When reduction
strategies are put in place and mental health consumers are still secluded: An analysis
of clinical and sociodemographic characteristics. International journal of mental
health nursing, 23(6), 506-512.
Canadian Patient Safety Institute. (2020). Mental Health Care: Seclusion and Restraint.
Retrieved 23 March 2020, from
https://www.patientsafetyinstitute.ca/en/education/PatientSafetyEducationProgram/

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PatientSafetyEducationCurriculum/MentalHealthModules/Pages/Mental-Health-Care-
Seclusion-and-Restraint.aspx
Chieze, M., Hurst, S., Sentissi, O., & Kaiser, S. (2019). Effects of Seclusion and Restraint in
Adult Psychiatry: A Systematic Review. Frontiers in psychiatry, 10, 491.
Colaizzi, J. (2016). Seclusion & restraint: A historical perspective. Journal of psychosocial
nursing and mental health services, 43(2), 31-37.
Lea, M., Beaupert, F., Bevan, N., Celermajer, D., Gooding, P., Minty, R., ... & Weller, P. J.
(2018). A disability aware approach to torture prevention? Australian OPCAT
ratification and improved protections for people with disability. Australian Journal of
Human Rights, 24(1), 70-96.
Lloyd, C., King, R., & Machingura, T. (2014). An investigation into the effectiveness of
sensory modulation in reducing seclusion within an acute mental health
unit. Advances in Mental Health, 12(2), 93-100.
Muskett, C. (2014). Trauma‐informed care in inpatient mental health settings: A review of
the literature. International journal of mental health nursing, 23(1), 51-59.
NSW Mental Health Act. (2020). NSW Mental Health Act – Mental Health Coordinating
Council. Retrieved 23 March 2020, from https://www.mhcc.org.au/project/nsw-
mental-health-act/
Phipps, M., Molloy, L., & Visentin, D. (2019). Prevalence of trauma in an Australian inner
city mental health service consumer population. Community mental health
journal, 55(3), 487-492.

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Procyshyn, R. M., Bezchlibnyk-Butler, K. Z., & Jeffries, J. J. (Eds.). (2019). Clinical
handbook of psychotropic drugs. Hogrefe Verlag.
Purpora, C., Blegen, M. A., & Stotts, N. A. (2015). Hospital staff registered nurses'
perception of horizontal violence, peer relationships, and the quality and safety of
patient care. Work, 51(1), 29-37.
Rao, T. S., & Andrade, C. (2016). Classification of psychotropic drugs: Problems, solutions,
and more problems. Indian journal of psychiatry, 58(2), 111.
Read, J., Fosse, R., Moskowitz, A. & Perry, B. (2014). The traumagenic neurodevelopmental
model of psychosis revisited. Neuropsychiatry, 4(1), 65-79.
Ross, D. (2018). A social work perspective on seclusion and restraint in Australia’s Public
Mental Health System. Journal of Progressive Human Services, 29(2), 130-148.
Shaddel, F., Ghazirad, M., O’Leary, D., & Banerjee, S. (2015). How psychotropic drugs are
used; an explanatory paradigm. Journal of Medical Hypotheses and Ideas, 9(2), S24-
S30.
Sung, J. E., Kim, S. J., Kim, S. H., & Kim, S. W. (2018). Nursing Strategy for Use of
Seclusion and Restraint in Psychiatric Hospitals. Korean Journal of Schizophrenia
Research, 21(1), 1-8.
World Health Organization. (2017). Strategies to end the use of seclusion, restraint and other
coercive practices: WHO QualityRights training to act, unite and empower for mental
health (pilot version) (No. WHO/MSD/MHP/17.9). World Health Organization.
Wright, M. (2017). Review of seclusion, restraint and observation of consumers with a
mental illness in NSW Health facilities. NSW Health.

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