Facing Fear and Change

Abstract

The intervention of seclusion is meant to be a measure of last resort, and there is increasing pressure within the mental health system to reduce or eliminate the use of seclusion and restraint for a number of persuasive reasons. This article describes the successful experience of integrating an unpredictably violent patient with autism who had been in seclusion on a forensic ward twenty-three hours per day on average, seven days per week, for seven years into the ward milieu and into the community with no further use of seclusion. Two of the authors are the main behavioral therapists who described the steps taken and the struggles faced in this process. Systemic barriers are reviewed, including concerns about staff and patient safety, the fear and resistance of front-line staff, and the culture shift needed to allow this patient the opportunity to make independent decisions and improve his quality of life.