Seclusion rooms are used to reduce the need for physical and mechanical restraints over prolonged periods of time. They can sometimes be used as a short-term measure to keep the patient safe while medication takes effect.
It is a sometimes controversial measure because of its significant potential for abuse or misuse.
What Is Seclusion?
Seclusion is the supervised confinement of a patient in a room, which may be locked to protect others from significant harm. Its sole aim is to contain severely disturbed behaviour, which is likely to cause harm to others.
Seclusion should be used as a last resort; for the shortest possible time. Seclusion should not be used as a punishment or threat; as part of a treatment programme; because of shortage of staff; where there is any risk of suicide or self-harm. Seclusion of an informal patient should be taken as an indicator of the need to consider formal detention.
Seclusion must be differentiated from asking a service user to go to a designated room for the purpose of calming down. The latter is a de-escalation technique — Time Out — and the seclusion room should not routinely be used for this purpose.
There is a possibility, however, that seclusion rooms could be re-purposed as Time Out rooms if this better reflected the therapeutic approach of the psychiatric department.
⚠️ Important: Seclusion is not a therapeutic intervention. It simply allows for a period of calming in the service user and should always be managed in a designated room, separating the service user from others and placing them in a positive therapeutic milieu (Cashin, 1996).
How Seclusion Fits Into the System
Seclusion forms part of a system of managing — in the short-term — disturbed or violent behaviour in emergency or in-patient psychiatric environments. The National Institute for Clinical Excellence (NICE) in the UK has created a visual flowchart of how these incidents should be managed.
Physical Intervention
Holding with force is used to enable rapid tranquillisation to take effect — but is contraindicated when holding is prolonged for long periods of time.
Rapid Tranquillisation (RT)
Used to avoid prolonged episodes of physical intervention and holding by force, by medically calming the person — but is contraindicated when the person has taken previous medication or is not working in a timely fashion.
Seclusion
May also be used to avoid long periods of physical intervention and holding by force. It is contraindicated when RT has taken effect and, among these three options, is the absolute last resort.
Seclusion should be used as a last resort; for the shortest possible time.
📊 The hierarchy: Physical Intervention → Rapid Tranquillisation → Seclusion. Each step exists to avoid the next. Seclusion is only considered when both Physical Intervention and RT are contraindicated or have failed.
Gerard O’Dea is a conflict management, personal safety and physical interventions training consultant. He is the training director for Dynamis, a specialist provider of personal safety and violence management programmes, and the European Adviser for ‘Verbal Defense and Influence’, a global programme which addresses the spectrum of human conflict.