Seclusion In Mental Health

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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,…show more content…
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 psychiatry and psychiatry’s suppression of personal autonomy and freedom (Buchanan-Barker & Barker 2009). As a result different perceptions of mental illness can impact how we deal with ethical dilemmas in psychiatry. The Mental Health Commission (2009) has set out strict guidelines and criteria around the use of seclusion
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