The therapeutic use of seclusion in a psychiatric clinic

Seclusion is still being widely used nowadays for the management and care of psychiatric patients, despite the open debate in place concerning its use in the scope of mental health. The use of seclusion is controversial as it is contrary to two different viewpoints; the one of those mental health professionals who support the use of seclusion in psychiatric units, on the basis of the theoretical principles of containment, safety and decrease of sensory input, as well as the one of those who are opposed to its use because of the moral and legal issues that arise. The aim of the review is to approach the existing literature on seclusion with a critical view, in order to (a) define the cases of studies concluding that the use of seclusion has been beneficial for psychiatric patients, (b) identify studies mentioning that seclusion has not been to the benefit of patients, and (c) identify gaps in literature concerning the use of seclusion as a therapeutic means, and thus to suggest topics for future investigation. A search in bibliography was carried out using the Cinahl (1982–2004), Medline (1970–2004) and Psycinfo (1970–2004) databases. From the literature search there have been contradictory findings as well as a lack of unanimity regarding the therapeutic aspect of seclusion. It is rather difficult to support rigorously that seclusion is a therapeutic mean. However, in the practice of psychiatric units, it seems that it acts complementary to the methods of treating psychiatric patients. Some research studies have offered evidence that the use of seclusion in terms of behaviour therapy could help the patient modify his/her behaviour. Nevertheless, the beneficial aspect of seclusion seems to differ from patient to patient and should not be generalized for every case. Thus, more studies with a thorough methodological design need to be conducted, in order to ascertain the use of seclusion as a therapeutic model applied in psychiatric care, and discover whether this approach of treatment is actually therapeutic.