Seclusion in mental health hospitals: exploring patient characteristics and reasons for seclusion

This thesis explores the causes and characteristics associated with seclusion, a restrictive practice used in mental health hospitals. Throughout, the population referred to will be inpatients within various types of mental health hospitals, ranging in security level and age group, as there is insufficient research solely within forensic settings. Literature is outlined detailing the reasons behind the use of seclusion and a focus is placed upon the characteristics of secluded inpatients. It is hoped that this contribution to the research base will compliment current efforts being made to reduce the use of seclusion in these settings. Chapter one outlines the use of seclusion in managing challenging behaviour in mental health hospitals. The impact of seclusion is discussed and in the absence of theories about seclusion, theories of aggression were outlined, as a significant number of these episodes are precipitated by aggressive behaviour. The second chapter considers the utility of the Violence Risk Scale in assessing psychiatric inpatients. A critical analysis of the psychometric properties is detailed and the limitations are explored. It is concluded that research tends to suggest that this measure may be valid and reliable for use in clinical settings. A systematic literature review is outlined in chapter three, describing the reasons for seclusion episodes as well as exploring other factors associated with its use. The review identifies various precipitating behaviours and finds actual violence, agitation and threat of violence to be the most common reasons for the initiation of seclusion. The fourth chapter presents a meta-analytic study on the characteristics of secluded inpatients, focusing upon the prevalence of specific demographics such as gender, diagnosis of psychosis and age. Limitations of this research and potential implications of these findings are discussed. Chapter five concludes the thesis with an overview of the findings in relation to the research base. Future directions for research are detailed and further implications for clinical practice noted