Locked Away

By Jim McVeagh 01/10/2009

An article in yesterday’s Dominion Post posted on Stuff caught my eye.

It featured a call to end the practice of “seclusion” – the isolation of a mental health patient in a bare room. What attracted my attention was the utter lack of any sort of attempt at balance or analysis. The article mainly featured the stories of two women would had been subjected to this technique. One had been in seclusion nearly forty years ago, and the other a decade ago. Both of their stories seemed quite horrible but their testimony was hardly currant. There was no comment from a mental health worker explaining why such a technique might be used. There was no comment from the Director of Mental Health services apart from a caution on reading too much into regional differences in seclusion rates. Presumably he was not asked the obvious question of why use it at all?

We were told that 16% of adult inpatients were secluded at some stage last year. We are not told how that compares with the past or how it compares with other countries. 10 minutes on google tells me that the rate in one hospital in Australia is 31% and the reasons for variability in rates in the US seem similar to ours. Once again, I am forced to conclude that health reporting is about creating a nice sensational story, without regard to the facts.

Seclusion is still widely used in the first world. Though some have decried it as a surrogate for adequate staff numbers, the simple fact of the matter is that some patients are, at least momentarily, a serious danger to others and cannot be safely handled, regardless of numbers of staff. I remember one psychotic patient who required two police officers, two orderlies and three nurses to hold him down while we gave him some sedation. He still managed to blacken the eye of one nurse, injure the lower back of another and break one of the policemen’s fingers.

In his case, we had no choice but to use sedation, but in less severe cases, seclusion is a much better and safer technique than large doses of drugs. Although the seclusion rooms are bare, there is usually some form of mattress on the floor with bedding and the room is warm. It is, after all, a form of restraint rather than a form of punishment.

As long as the unit has adequate protocols in place which dictate the criteria for seclusion, how it is monitored and when it should cease, I have absolutely no difficulty with this technique. It’s use should be properly monitored and it’s effectiveness judged scientifically rather than by the histrionic ramblings of the media.