Seclusion reviews in secure settings

by Dr Gaurav Sharma, Dr David Reiss and Jonathon Lynch

 

Published: January 2016

 

Seclusion is a method used by mental health teams around the world to manage aggressive and disturbed behaviour in psychiatric patients, in situations where there is an immediate risk of harm to others.

 

It is particularly important when hospital care is provided to the most unwell or highest-risk patient groups, such as those requiring forensic or similarly secure environments. Use of seclusion can be controversial; therefore we have a huge responsibility as psychiatric professionals to ensure that its use is judicious.

 

This module highlights guidance from the 2015 version of the Mental Health Act 1983 Code of Practice. It covers the definition of seclusion, the circumstances in which seclusion might be considered as a last resort, and situations in which it should not be used. The module looks at the features of a seclusion area and the practicalities of secluding a patient. It also lists prevention and safety-planning measures for minimising the use of seclusion where possible, and provides two clinical vignettes.

 

When someone has been secluded, a series of review processes should be initiated. The module outlines what should be discussed in a pre-review meeting and what should be considered in the patient’s seclusion care plan. It then covers the seclusion review and what should happen afterwards. Learning is supported by a series of video clips showing a seclusion scenario. The videos include a pre-review meeting, the review in the seclusion room, and the post-review meeting in which the team decides whether to continue or terminate the seclusion.

 

The module also explores the use of seclusion for longer periods, special considerations for patients with particular needs, and the legal implications of secluding a patient.

 

Start the module

 

If you like this module, you may also be interested in:

 

Rapid tranquillisation of the acutely disturbed patient by Dr Stephen Pereira, Dr Deepak Garg and Dr David Branford

 

Risk assessment and management of violence in general adult psychiatry by Dr Fiona Toal, Professor Paul Mullen and Professor James Ogloff

 

Managing challenging behaviour in mental health in-patient units by Dr Dominic Beer and Mr Anthony Davis

 

Book from RCPsych Publications: Prevention and Management of Violence: Guidance for Mental Healthcare Professionals

 

 

Download take-home notes to print and annotateDownload take-home notes to print and annotate

 

This module is a joint commission with the following article published in BJPsych Advances:

 

Newton-Howes G (2013) Use of seclusion for managing behavioural disturbance in patients. BJPsych Advances, 19: 422–428. [abstract]

 

Other related Advances articles

 

© 2017 Royal College of Psychiatrists