Seclusion Room: A Case Study

Seclusion is defined by the Mental Health Commission (2009 p.19) as ‘the placing or leaving of a person in any room alone, at any time, day or night, with the exit door locked or fastened or held in such a way as to prevent the person from leaving.’ Newton-Howes (2013) further describes the seclusion room as a locked room, which is sparsely furnished with little detached or hazardous objects in a reduced stimulus environment to promote the regaining of self-control following a period of acute mental distress. The Mental Health Commission recorded 1,403 episodes of seclusion in 2012. According to Gutheil (1978 as cited in Muir-Cochrane 1995) the purpose of seclusion can be identified through three dimensions: the management of unwell persons,

as cited in Roberts 2004).
Autonomy is described as an individual’s right to self-governance around their care and the requirement of healthcare professionals to respect these decisions (Kirby et al. 2004). However the patient and healthcare professional can sometimes have conflicting views regarding a person’s capacity for autonomy particularly persons who are acutely unwell. Despite JB expressing his dislike of being placed in seclusion, nursing and medical staff agreed JB’s capacity to make an informed autonomous decision was impaired due to his current mental distress. Roberts (2004) states that the paternalism in mental health is rationalized through the concept that mental illness can inhibit a persons’ competency and ability to act autonomously in the governance of their care and therefore principles of beneficence and non-maleficence must be introduced to ensure that person receives adequate care. Prinsen & van Delden (2009) also argue that coercive measures such as seclusion can be necessary in reclaiming personal autonomy and control. However this paternalistic viewpoint of overruling a patient’s autonomy is arguable especially if a person is deemed incompetent due to their mental illness. Szasz believed mental illness was mythical and the introduction of a diagnosis was merely to label social deviancy from social norms. Therefore Szasz challenged the paternalistic practices of coercive and powerful

One form of consequentialism is the theory of utilitarianism, which presents an ethical argument from the perspective of the benefit of the greater good with rights and obligations becoming secondary to public welfare (Williams 2009). Bentham presented the idea that the action can be concluded as right if the greatest positive outcomes occurs with Mill modifyinh this theory further to explain the ultimate goal of utility as the greatest amount of satisfaction for the general population (Muir-Cochrane 1995). Therefore the override of a patient’s autonomy for the greater good can be justified by the utilitarianism theory and in the case of JB justifies the reasoning of placing an aggressive and violent JB in seclusion to ensure safety of the patients and staff, to maintain a harmonious and secure environment and to maintain the therapeutic milieu on the ward. However utilitarianism principles can be criticized as it is not possible to measure the satisfactory amount of happiness or unhappiness described by this theory, therefore leading to differing opinions defining ‘best’