Milieu Therapy Research Articles

Treatment Effects of Introducing the Neurosequential Model of Therapeutics in a Norwegian Residential Treatment Facility for Children Aged 7-13.

This study investigates the impact of the Neurosequential Model of Therapeutics (NMT) in child and adolescent psychiatric care, addressing a gap in current clinical methodologies that tend to focus on single problems rather than the interconnected nature of many real-life mental health issues. The study was conducted in a residential setting over an extended period, including children aged 7-13, to observe the effects of implementing NMT. The children presented with complex symptoms and multiple diagnoses. The methods incorporated the NMT approach, emphasizing individualized treatment plans based on each child's unique brain development, and aimed at addressing multiple, interconnected problems simultaneously. Results from multilevel model analyses of behavioral difficulties, measured using the Child Behavior Checklist (CBCL), revealed substantial improvements in treatment effectiveness post-NMT implementation. Despite the limitations, such as a non-randomized participant selection and limited sample size, the findings strongly suggest that NMT enhances care effectiveness in real-world clinical settings, particularly for children with complex mental health issues. The study concludes that relationally oriented milieu therapy, and specifically the NMT approach, holds great promise for advancing pediatric psychiatric care, advocating for its broader application and further research to refine and substantiate its efficacy.

DRD4 VNTR 4/4 homozygosity as a genetic biomarker for treatment selection in patients with schizophrenia

ObjectiveThere seems to be an association between the DRD4 48-bp VNTR polymorphisms and antipsychotic treatment response, but there is a rare reference to confirm this finding. Hence, the present study tried to investigate the association between DRD4 48-bp VNTR polymorphisms and the treatment response of antipsychotics in patients with schizophrenia in Taiwan, using a propensity score matching (PSM) method. MethodsA total of 882 participants were enrolled in this study and completed informed consent, research questionnaires, including demographic information and the revised Chinese version Beliefs about Voices Questionnaire, and blood sampling. For descreasing of the selection bias and confounding variables, the PSM nearest neighbor matching method was used to select 765 paitents with schizophrenia (ratio of 1:8 between 85 persistent auditory hallucination and 680 controls) with matched and controlled the age and gender. ResultsSchizophrenia patients with DRD4 4 R homozygosity had a lower rate of good antipsychotic treatment response than the other DRD4 genotype carriers (DRD4 non-4/4). Among those 4 R homozygosity carriers, 60 cases of 503 (11.9%) retain persistent auditory hallucinations. Furthermore, this subgroup of patients is accounted for up to 70.6% of cases with poor neuroleptic treatment response. ConclusionsA poor treatment outcome for patients with the 4 R homozygosity had presented,that comparing with those DRD non-4/4 genotype carriers. DRD4 VNTR 4 R homozygosity could be a genetic biomarker to predict poor antipsychotic treatment response in schizophrenia. Patients with DRD 4/4 probably receive novel antipsychotic medications preferentially or in combination with alternative therapy, such as psychotherapy or milieu therapy.

Medication-free mental health treatment: a focus group study of milieu therapeutic settings

BackgroundMedication-free treatment within mental health care aims to offer therapeutic support as an alternative to psychotropic medication. Introducing milieu therapy for severely mentally ill persons in a medication-free unit requires significant changes to the traditional medication-based psychiatric setting. The present study examines how milieu therapists experience working with medication-free treatment for people with severe mental health challenges. The research question was “What may be required to succeed with medication-free treatment in milieu therapeutic settings?”MethodsA qualitative study with four focus groups were conducted with 23 milieu therapists from three inpatient units in two mental health institutions. Thematic analysis was performed.ResultsOne main theme was identified: medication-free treatment involves therapists and patients working together on holistic and personal health promotion. This common thread links the four themes: helping patients to make changes in their life; having time to focus on the individual patient; being a professional companion; and working together as a team with the patient.ConclusionsA holistic approach is necessary for medication-free treatment to succeed. This requires working together in multidisciplinary teams with a focus on the individual patient. Milieu therapists must engage and take more responsibility in the patient’s process of health promotion. A change from a medical to a humanistic paradigm within mental health care is needed.

Impact of Environment and Milieu Therapy in Palliative Care.

The collaborative approach offered by palliative care benefits both patients and their caregivers. They provide a system of support that enables patients to lead as active a life as possible. This integrative review aimed to find out whether milieu and environment therapy has a significant impact on palliative care patients. Analyses and summaries of seventeen (17) papers were completed. There were three themes identified: environmental factors for quality of life, milieu therapy in forms of arts and music, and milieu therapy is safe, structured, and psychotherapeutic. This review demonstrates that milieu and environment therapy may also help to reduce physical symptoms, such as pain, and enhance quality of life. The study suggests that even if there are many interventions for palliative patients, more research is needed to generate a more thorough evaluation of the efficacy of various environmental control components and milieu therapies for palliative care patients.

Milieu therapy based on local virtue influence on community acceptance on post restriction mental disorder patients at home

Introduction: Rehabilitation post-restriction conditions are for patients who need excellent help. Environmental therapy is one of the modalities of nursing therapy that is useful for creating a conducive environment. This study aimed to analyze the effect of local-based therapy on receiving community to patients about post-restriction safety issues at home.

Use of Therapeutic Milieu Interventions in a Psychiatric Setting: A Systematic Review.

BACKGROUND:The therapeutic environment is commonly acknowledged as a significant influence on mental inpatient treatment experiences and outcomes. Therapeutic milieu interventions provide a distinct, secure hospital ward/unit atmosphere where patients with mental illness receive therapeutic interactions and collaborative attentiveness. The review aimed to explore the studies related to the role of a nurse using therapeutic milieu/milieu therapy in a psychiatric setting.MATERIALS AND METHODS:A systematic literature search was conducted between 1976 and 2021 using PsycINFO, Medline, Embase, and Scopus. A total of 13 papers were identified for a full review.RESULTS:A total of 70 studies were found, out of which 13 of them were analyzed. These studies looked at several therapeutic milieu concepts, such as therapeutic communication, patient satisfaction, nurse involvement, ward design and structure, and a mixture of therapeutic milieu concepts. Most of the studies explored the concepts of milieu therapy in community settings.CONCLUSION:In the mental health nursing literature, the milieu, as well as milieu therapy, is a well-debated subject. Though the importance of therapeutic milieu in psychiatric settings is recognized, empirical studies on milieu implementation are scarce. Therefore, research is needed to explore the effectiveness of milieu therapy in inpatient psychiatric care, which facilitates patient recovery, safety, and good interpersonal relationships.

Treating Agitation in Patients with Dementia with a Therapy Dog in a Milieu Therapy Setting on a Geropsychiatric Ward

Background: Animal-assisted intervention has become a common therapeutic practice used for patients with dementia in home-dwelling and institutions. The most established procedure is a visiting service by specially trained dogs and their owners to improve social interactions and reduce symptoms of agitation. Objectives: The study aims to investigate the effects of a therapy dog on agitation of inpatients with dementia in a gerontopsychiatric ward. Materials and Methods: The severity of agitation was assessed by a rater blinded for the presence of the dog via the Overt Agitation Severity Scale (OASS). The scale was conducted on 1 day with the dog and his handler present (resident doctor on the ward) and on another day with only the handler present. Each patient was his/her own control. Heart rate variability (HRV) and serum level of brain-derived neurotrophic factor (BDNF) of the patients were measured on both days. 26 patients with the Mini-Mental Status Examination (MMSE) score <21 and the diagnosis of dementia were included in the study. Results: A significant reduction of agitation in the OASS could be shown when the dog was present (p = 0.006). The data neither demonstrated a difference in the HRV for the parameters mean heart rate (p = 0.65), root mean square of successive differences (p = 0.63), and high frequencies (p = 0.27) nor in serum BDNF concentrations (p = 0.42). Discussion: Therapy dogs can be implemented as a therapeutic tool in a gerontopsychiatric ward to reduce symptoms of agitation in patients with dementia. The study was registered in the German Clinical Trials Register (DRKS00024093).

Bridge over Troubled Water: Patients' Opportunities for Collective Participation in Substance Use Institutions through Research Circles.

This study explores patients’ opportunities for collective participation in an institution for people with substance use disorder. Patients and staff from the treatment institution cooperated with researchers to make changes in the treatment practice, using a research circle as a model for the project. In the article, we discuss the following research questions: How and in what areas did patients have the opportunity to participate collectively in the treatment institution? How did the patients experience participation in the research circle? Data consist of minutes from meetings, seminars, and focus-group interviews. The participants analysed the material together, and the authors carried out a thematic analysis after the project. The participants chose to explore how milieu therapy could build a bridge from treatment in the institution to life after treatment, a “Bridge over troubled waters”, to quote Simon and Garfunkel. Findings show that activities in the research circle led to changes at the institution, e.g., regular Sunday afternoon meetings, a weekly quiz, and less controlling procedures of substance use, and that the institutional culture in general became based more on participation and equality. Patients, staff, and researchers participated in a partnership; mutual recognition promoted cooperation and fellowship in the research circle. We conclude that the project provided the participants with opportunities for collective participation in the institution. In addition, the patients experienced partnership and empowerment in the research circle. Our attempts to change institutional practices yielded some improvements but also met with structural and cultural barriers. Thus, the project experienced challenges and obstacles mostly related to limitations in the institutional system and culture.

Міліотерапія як метод покращення якості життя літніх людей

Relevance. Nowadays, both in developing countries and in industrialized countries, there is a process of increasing life expectancy, which together with the problem of low birth rates leads to the phenomenon of “aging population”. Providing care to the elderly is not only a purely medical problem, but the social aspect is equally important. An important component of the lifestyle of an elderly person is recreation - the processes of restoring vitality, relieving mental stress and recovery, carried out in various forms of recreation, nutrition, active or passive leisure. Modern society and the health care system face three most important tasks: continuing an active life with minimal losses from the disorders inherent in old age, combating high morbidity in old age and ensuring a dignified end to the lives of aging people. Although the provision of medical and social assistance to the elderly is organized and provided as needed, ensuring the accessibility and sufficient presence in their lives of the social aspect and its communicative component is not supported in our country at the state level and is not regulated by law. Purpose. The purpose of the work is to improve the quality of life of the elderly through the organization of the social component of life by arranging their leisure. Results. To achieve this goal, it was proposed to use the principles and methods of milieu therapy, which means “treatment by the environment”. Most often, milieu therapy refers to a form of psychotherapy that involves the use of therapeutic communities. Considering the goal, milieu herapy fully covers and meets the goals of rehabilitation of the elderly, and as a social technology allows to create an active living environment that encourages older people to “independent actions”, self-sufficiency, withdrawal from dependent moods and hyperprotection. Milieu therapy allows to activate the living environment of such people in accordance with their needs, interests, psychophysical condition, rehabilitation potential; and to optimize the work of staff in the direction of improving the efficiency of activities that will have a direct impact on quality of life. On the example of other countries, examples of the use of the principles of milieu therapy in the organization of daytime activities in the elderly are provided. Conclusions. Providing leisure for the elderly will be able to improve their quality of life, reduce the prevalence of somatic diseases and the risk of developing psychosomatic conditions in them, and thus reduce the burden on health care facilities. And the use of the principles of milieu therapy to solve problems will allow to organize it as effectively as possible.

Effectiveness of therapeutic milieu intervention on inpatients with depressive disorder: A feasibility study from North India.

This study examined therapeutic milieu interventions on self-esteem, socio-occupational functioning, and depressive symptoms among inpatients with depressive disorders. A pretest-posttest nonequivalent control group quasi-experimental design was adopted. Sixty participants with depression who got admitted to the general hospital psychiatric ward were assigned to a control (Treatment as Usual) group and an experimental (therapeutic milieu intervention) group nonrandomly using a convenience sampling technique. We evaluated the following outcome measures: self-esteem, socio-occupational functioning, and depressive symptoms for both groups at baseline, 4th, 8th, and 12th weeks. Therapeutic milieu interventions improved self-esteem, socio-occupational functioning, and reduced depressive symptoms. The findings provided initial evidence for practice. Psychiatric nurses can implement simple, milieu therapy interventions in any setting, which will enhance the clinical outcomes and socio-occupational functioning of depressive patients.

Millieu Therapy Metode Kreasi Seni Modifikasi Lingkungan Terhadap Tingkat Harga Diri Remaja

Adolescence is a transition period between childhood and adulthood. Massive changes from childhood to adulthood are common at ages 13 to 20 years. Previous research discusses the difficulties of social interaction with peers, social relationships with groups, and difficulty communicating with a social new environment. Some students expressed stress with the number of Islamic boarding school rules, controlled and far from parents. At the same time, 32% of people agreed that they were not confident, sad, anxious, afraid of intimidation, and decreased learning enthusiasm. People who looked down on trust would have an external and internal impact. The external consequence is difficulty reaching academic achievement and social relations. The internal consequence is difficulty reaching internal self-concept, unclear, complicated, uncertain self goals, and pessimistic in the future challenge. This study aimed to know the level of self-esteem of students after being given milieu therapy with environmental modification art creation. The study design uses pre-experimental with pre-post test design of one group. The sampling technique was purposive sampling. Samples were taken as many as 24 respondents and divided into 4 groups of 6 people in each group. The intervention was given for 3 weeks. In this study, measuring instruments used a questionnaire using Rosenberg and data analysis using the Wilcoxon test signed a ranking test. The statistical analysis showed the results of p = 0.030 &lt;α. There was a milieu effect of therapeutic methods of environmental modification art creation on students' level of self-esteem living in the dormitory. Milieu therapy can increase awareness and self-confidence between peers with the approval of self-confidence and commitments agreed between friends.

Design and Implementation of a Regional Inpatient Psychiatry Unit for Patients who are Positive for Asymptomatic SARS-CoV-2

BackgroundPatients with psychiatric illnesses are particularly vulnerable to highly contagious, droplet-spread organisms such as SARS-CoV-2. Patients with mental illnesses may not be able to consistently follow up behavioral prescriptions to avoid contagion, and they are frequently found in settings with close contact and inadequate infection control, such as group homes, homeless shelters, residential rehabilitation centers, and correctional facilities. Furthermore, inpatient psychiatry settings are generally designed as communal spaces, with heavy emphasis on group and milieu therapies. As such, inpatient psychiatry services are vulnerable to rampant spread of contagion.ObjectiveWith this in mind, the authors outline the decision process and ultimate design and implementation of a regional inpatient psychiatry unit for patients infected with asymptomatic SARS-CoV-2 and share key points for consideration in implementing future units elsewhere.ConclusionA major takeaway point of the analysis is the particular expertise of trained experts in psychosomatic medicine for treating patients infected with SARS-CoV-2.

Milieu therapy for hospitalized patients with late-life anxiety and depression: a qualitative study

Background: Milieu therapy (MT) is an important interprofessional part of therapy for persons with late-life anxiety and depression in psychogeriatric inpatient units. Research on how this is conducted is scarce. Aim: To explore nurses’ and nurse assistants’ experience regarding MT interventions for persons with late-life anxiety and depression and how this is applied and conducted in the everyday life in a psychogeriatric inpatient unit. Method: Four focus group interviews with nurses and nurse assistants were conducted. Systematic text condensation was used for analyzing and interpreting the data. Results: MT was described as a dynamic and active process. Conscious individualized cooperation and communication day and night emerged as overarching theme, with following categories: 1. Collecting clues about the patient’s history, challenges and coping strategies. 2. Active use of these clues. 3. Active use of the ward setting as arena for staff to learn from each other, for patients to learn from other patients and as frame for MT in general. Strategies from both psychiatric and dementia care were used in MT interventions. Conclusion: Results from this study describe content and complexity of MT strategies that can be supportive in everyday practice in psychogeriatric inpatient units and nursing homes, and have the potential to facilitate teaching, supervision and counseling of health professionals, caregivers and patients

Inpatient Milieu Therapy: Considerations for Adolescent and Transitional Age Youth

Background and Goals: The role of milieu therapy on inpatient treatment has become more prominent due to the changing landscape of hospital care, with shorter length of stay, higher patient acuity, and rapid turnover. The modern inpatient unit promotes less individual psychotherapy with the psychiatrist or therapist, and more milieu and group based treatment that emphasizes acute stabilization. Methods: The authors share some of the core domains that provide the basic framework for milieu treatment within an acute care setting when working with adolescents and transitional age youth (TAY), with the aim to share clinical considerations for milieu therapy and offer practical ideas for implementation in clinical practice. Discussion: The therapeutic milieu and collaboration of an interdisciplinary team has a significant impact on hospital treatment. Considerations for milieu therapy implementation in an inpatient unit include developmentally informed concepts related to milieu treatment of adolescents and TAY patients in a hospital setting.

CULTURALLY-SENSITIVE PSYCHIATRIC NURSING CARE: AN IMPORTANT PRELIMINARY INTERVENTION IN COMMUNITY-BASED ACUTE CARE SETTINGS

ABSTRACKPsychiatric nursing care is an indispensable aspect of the total health care services provided by nurses in both the acute and chronic care settings. This study investigated the extent of preliminary clinical nursing care provided by registered nurses in dealing with clients who have unique psycho-behavioral needs. It further looked into the relationship between the nurses’ socio-economic profile including their ethnic affiliation and the acute care services offered to patients admitted in the regular hospital, non-psychiatric healthcare settings. It used a descriptive-correlational design through a validated and reliability-tested instrument responded by 113 staff nurses from six hospitals around Lanao del Sur. It involved the statistical analysis of data using frequency, weighted mean, and Pearson correlation. The findings show that the nurse-respondents of the selected hospitals in Lanao del Sur generally considers the extent of implementation of the six nursing care areas (counseling, milieu therapy, self-care activities, psychobiologic interventions &amp; health-teachings, case management, health promotion and maintenance) as frequently done or as generally emphasized in about 75% of the time in their respective clinical areas. When tested at 0.05 level of significance, the p-value obtained was less than the critical value (p=0.00-0.006) revealing that the ethnic affiliation of nurses was significantly correlated to the health promotion and maintenance care that they provide to clients with psycho-behavioral pathologies. Therefore, nurses serving in acute clinical settings need to possess a significant amount of competency in psychiatric care to be able to render preliminary interventions despite non-specialist background. Nurses also have to be cognizant of the cultural history and background of the clients being served even at the preliminary phase of the nurse-patient interaction and accommodate them with nursing interventions based on transcultural competence.Keywords: Culturally-sensitive psychiatric care, psycho-behavioral pathologies, preliminary psychiatric interventions, psychiatric care in acute settings

Community reintegration following holistic milieu-oriented neurorehabilitation up to 30 years post-discharge.

The primary goal of neurorehabilitation for individuals with acquired brain injury (ABI) is successful community reintegration, which commonly focuses on home independence, productivity, and social engagement. Previous research has demonstrated that holistic treatment approaches have better long-term outcomes than other treatment approaches. Holistic approaches go beyond the fundamental components of neurorehabilitation and address metacognition and self-awareness, as well as interpersonal and functional skills. The present study aimed to examine community reintegration of individuals with ABI who completed holistic milieu-oriented neurorehabilitation at the Center for Transitional Neuro-Rehabilitation (CTN), Barrow Neurological Institute (BNI) at up to 30-years post-discharge. We evaluated (a) functional independence, (b) productivity and driving status, and (c) psychosocial profiles of the brain injury survivors. Participants included 107 individuals with ABI with heterogeneous etiologies who attended holistic milieu-oriented neurorehabilitation between 1986 and 2016. These participants completed the Mayo-Portland Adaptability Inventory-4 (MPAI-4) and a long-term outcome questionnaire (LOQ) specifically developed for this study. The results demonstrate that 89% of participants were productive at up to 30 years post-discharge (73% engaged in competitive work and/or school) after excluding the retired participants. Almost all of the participants who were engaged in work and/or school reported using compensatory strategies on a long-term basis. Furthermore, only 14% out of 102 study participants were driving at the time of program admission; whereas 58% out of 96 were driving at the time of discharge; and impressively, 70% out of 107 participants were driving at the time of follow-up. Regression analyses revealed that older age at the time of injury, shorter duration between injury and treatment, and better functionality indicated by lower MPAI-4 Ability Index scores significantly predicted a return to driving status at the time of study participation. Psychosocial data from the LOQ revealed positive findings with respect to patients' marital status, living situation, income, and quality of social life. The findings from this study suggest that functional gains made during holistic neurorehabilitation have enduring effects and that patients can benefit highly from holistic milieu therapy beyond the early post-acute phases of their recovery. Additionally, they provide evidence that there is potential to return to driving, years after treatment completion.Our holistic milieu treatment approach addressing metacognition, self-awareness, social and coping skills training, and actively transitioning to community settings, is thought to have contributed to the exceptional and long-lasting outcomes in this study.

Effectiveness of Milieu Therapy in reducing conflicts and containment rates among schizophrenia patients.

Objective. To evaluate effectiveness of Milieu Therapy in reduction of conflict and containment rates among schizophrenia patients. Methods. This study utilized quasi experimental non-equivalent control group pre-post design. One hundred schizophrenia patients admitted in acute psychiatric wards were non-randomly assigned to either of the experimental (n=50) or control group (n=50). The experimental group received both milieu therapy and routine hospital treatment. The Milieu Therapy intervention Included environmental modification and structuring ward activities, establishing effective interaction with patient, and teaching caregivers on managing conflict behavior of patient. The control group received only routine treatment in the hospital. Outcome measures on conflict and containment rates were evaluated for both the groups at baseline and at 2nd, 3rd and 15th day. The Patient-Staff Conflict Checklist Shift Report (PCC-SR) was used to collect information about rates of conflict and containment.Results.Compared with control group, the experimental group participants showed decrease in aggressive behavior, self-harm behavior and general rule breaking behavior at baseline and 2nd, 3rd and 15th day (F=4.61, p<0.004, η 2=0.04; F=11.92, p<0.001, η 2=0.11; F=6.94, p<0.001, η 2=0.06) over seven days interval. Conclusion. The present study findings provided evidence for the effectiveness of integrating Milieu Therapy in psychiatric acute wards in reducing conflict behaviors among schizophrenia patients. Milieu therapy should be considered as an integral part of psychiatric care settings in these patients.

Development of an After-School Day Treatment Program for Children with Severe Emotional/Behavioral Disturbances.

This article introduces Aizone, an after-school day treatment program for children with emotional/behavioral disturbances, and examines its effectiveness. Aizone targets children whose problems require intensive care, but are not severe enough to warrant hospitalization, and prioritizes those from low-income families. Based on the bio-psycho-social model, this program provides a variety of therapeutic interventions for both children and their parents, including individual and group therapy integrated under the concept of milieu therapy, as well as community linkage services. This study uses a prospective comparative method to examine the effectiveness of Aizone by comparing and validating the treatment outcomes of seven Aizone programs across Seoul. The Korean Child Behavior Checklist was administered by caregivers before and after intervention and the data was used in a repeated measures analysis. The effectiveness of the program in terms of reduction in emotional, behavioral symptoms, as well as the implications of the results are discussed.

Combination of TMB and CNA Stratifies Prognostic and Predictive Responses to Immunotherapy Across Metastatic Cancer.

Although tumor mutation burden (TMB) has been well known to predict the response to immune checkpoint inhibitors (ICI), lack of randomized clinical trial data has restricted its clinical application. This study aimed to explore the significance and feasibility of biomarker combination based on TMB and copy-number alteration (CNA) for the prognosis of each tumor and prediction for ICI therapy in metastatic pan-cancer milieu. Non-ICI-treated MSK pan-cancer cohort was used for prognosis analysis. Three independent immunotherapy cohorts, including non-small cell lung cancer (n = 240), skin cutaneous melanoma (n = 174), and mixed cancer (Dana-Farber, n = 98) patients from previous studies, were analyzed for efficacy of ICI therapy. TMB and CNA showed optimized combination for the prognosis of most metastatic cancer types, and patients with TMBlowCNAlow showed better survival. In the predictive analysis, both TMB and CNA were independent predictive factors for ICI therapy. Remarkably, when TMB and CNA were jointly analyzed, those with TMBhighCNAlow showed favorable responses to ICI therapy. Meanwhile, TMBhighCNAlow as a new biomarker showed better prediction for ICI efficacy compared with either TMB-high or CNA-low alone. Furthermore, analysis of the non-ICI-treated MSK pan-cancer cohort supported that the joint stratification of TMB and CNA can be used to categorize tumors into distinct sensitivity to ICI therapy across pan-tumors. The combination of TMB and CNA can jointly stratify multiple metastatic tumors into groups with different prognosis and heterogeneous clinical responses to ICI treatment. Patients with TMBhighCNAlow cancer can be an optimal subgroup for ICI therapy.

Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals

BackgroundSeclusion is an invasive clinical intervention used in inpatient psychiatric wards as a continuation of milieu therapy with vast behavioural implications that raise many ethical challenges. Seclusion is in Norway defined as an intervention used to contain the patient, accompanied by staff, in a single room, a separate unit, or an area inside the ward. Isolation is defined as the short-term confinement of a patient behind a locked or closed door with no staff present. Few studies examine how staff experiences the ethical challenges they encounter during seclusion. By making these challenges explicit and reflecting upon them, we may be able to provide better care to patients. The aim of this study is to examine how clinical staff in psychiatric inpatient wards describes and assess the ethical challenges of seclusion.MethodsThis study was based on 149 detailed written descriptions of episodes of seclusion from 57 psychiatric wards. A descriptive and exploratory approach was used. Data were analysed using qualitative content analysis.ResultsThe main finding is that the relationship between treatment and control during seclusion presents several ethical challenges. This is reflected in the balance between the staff’s sincere desire to provide good treatment and the patients’ behaviour that makes control necessary. Particularly, the findings show how taking control of the patient can be ethically challenging and burdensome and that working under such conditions may result in psychosocial strain on the staff. The findings are discussed according to four core ethical principles: autonomy, beneficence, non-maleficence, and justice.ConclusionEthical challenges seem to be at the core of the seclusion practice. Systematic ethical reflections are one way to process the ethical challenges that staff encounters. More knowledge is needed concerning the ethical dimensions of seclusion and alternatives to seclusion, including what ethical consequences the psychosocial stress of working with seclusion have for staff.