Being in a Seclusion Room: The Forensic Psychiatric Inpatients' Perspective.

Abstract

Existing qualitative research has found inpatient service users to experience seclusion as highly distressing, with feelings of vulnerability, abuse and neglect often featuring in participants' accounts. The physical environment of the seclusion room and the interaction with clinical staff shape service users' personal seclusion experience. The majority of research on this topic focuses on seclusion within other restrictive practices. This paper provides new knowledge on one specific component of seclusion, the experience of being in the room, and draws attention to the specific psychological needs of service users during that aspect of their experience. This research provides new knowledge by exclusively exploring forensic inpatients' experience of the seclusion room, an under researched and often stigmatized population. The findings support the need for a caring and non-threatening therapeutic interaction with a secluded service user for the duration of time they are in the seclusion room. The findings suggest that necessary nursing procedures, such as observations, should be carried out discretely and sensitively to avoid service users feeling abused and frightened. Introduction Contemporary qualitative research has explored service users' experience of seclusion and has found it to be a highly distressing and potentially traumatizing experience for service users. The majority of the existing literature has researched seclusion within the context of other restrictive practices, resulting in findings that can only be considered an overview of the experience. The studies also rarely access participants with histories of considerable violence and imprisonment. Question What is forensic psychiatric inpatients' experience of being in a seclusion room? Method Seven inpatients in a medium secure hospital were interviewed, and interpretative phenomenological analysis (IPA) was used to analyse the data. Results Four superordinate themes were identified: "intense fear," 'not getting the care I needed," 'I am being abused" and "power struggle." Discussion While participants were in the seclusion room, they experienced extreme fear. Staff interaction played a considerable role in shaping the participants' experience. Staff actions were interpreted as neglectful and abusive. Participants experienced struggling for power with staff, seeking out power when left in a powerless position. Implications for practice These findings suggested that a carefully tailored therapeutic interaction is required during seclusion in order to safeguard the mental health of forensic inpatients.