Abstract
This paper reports on research undertaken in a high security psychiatric hospital in the United Kingdom which manages those patients considered dangerous, violent or having criminal propensities. In these special hospitals violence and aggression are common features and staff respond to these threats in a number of ways. One common approach is to employ the use of seclusion, which isolates the patient away from human contact until he or she is considered no longer an immediate danger to others. Data were collected on 95 seclusion episodes over a six month period. The hypotheses addressed whether: (a) there was a higher frequency of seclusion in response to actual violence over threatened violence; (b) the recording of mental states indicated increased severity for those who had been secluded due to threatening or attacking staff; and (c) there was an increased duration of seclusion when staff are attacked in relation to patients being the target. The results suggested that there was an over-prescription of seclusion in response to actual violence and, despite the lack of mental state assessments to support this, a significantly longer duration of seclusion when staff were targeted. This raises the question as to whether there is a punitive element to the use of seclusion.
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