Seclusion is a vexed issue in New Zealand with most Kiwis blissfully unaware of its existence in the world of mental health in this country. The fact is that about 17 people a week are put in seclusion and Maori make up about a 38% of these.
So what is seclusion?
According to the office of the Director of Mental Health in its Annual Report 2012 seclusion is defined as ‘where a consumer is placed alone in a room or area, at any time and for any duration, from which they cannot freely exit’. Seclusion can only be used when its necessary for the care or treatment of a consumer or for the protection of other consumers. But many people feel the practice is used all too often, to the point where it’s perceived as a punishment. I have personally heard someone threatened with being ‘locked up’ if they don’t behave by a staff member.
A typical scenario might be where someone is shouting or arguing with another consumer or smoking on the ward or refusing to accept instructions from a staff member. I know of cases where people have been secluded for holding hands, having sex, masturbating, disagreeing with staff or sitting to close to someone else. In my view none of these incidences needed seclusion. Action was required but solitary confinement was a step too far. The threat of seclusion often ramps up a situation, making it more volatile. When what’s needed is a calming, gentler approach to de-escalate the incident to the point where further intervention is not required. This is the ideal, but it maybe more time consuming, but still worth giving it a shot.
Why is seclusion bad.
As far as I can tell solitary confinement has no therapeutic benefit at all. In fact, the process of secluding someone can do more harm than good. Many people feel traumatise at being forcibly removed from a ward setting. It can trigger Post-Traumatic Stress events and people are often ‘drugged up’ as part of the process. Even the UN has described the practice as ‘cruel, inhuman, or degrading’. It is also an attack on the person. There are other reasons why solitary confinement should be ruled out of the equation. A person can become disorientated, losing a sense of time and place, they can feel abandoned and less trusting of the clinical team as well as feeling resentful.
According to the Office of the Director of Mental Health Annual Report 2011’Seclusion should be an uncommon event and should be used only when there is an imminent risk of danger to the individual or others and there is no other safe and effective alternative is possible.’
It’s good to know that District Health Board’s (DHB’s) are actively working to reduce seclusion, but their progress seems painfully slow, with only one DHB publicly setting a target to completely ban the practice. Tairawhiti has set 2020 as the target to abandon seclusion. Indeed, there is a measurable decline in the use of seclusion across the country and that is a good thing for mental health in New Zealand. It seems there is a desire for cultural organisational change inside DHB’s and it’s not before time.
Read more on the state of seclusion in NZ: