Patients’ experiences of seclusion rooms in forensic settings.
Research type
Research Study
Full title
A study exploring patients’ experiences of seclusion practices in forensic mental health services.
IRAS ID
370611
Contact name
Dr Filipa Alves-Costa
Contact email
Sponsor organisation
Noclor on behalf of North London NHS Foundation Trust
Duration of Study in the UK
1 years, 0 months, 1 days
Research summary
Forensic psychiatric patients tend to present with complex mental health needs, personality related difficulties and offending behaviour histories. Thus, treatment within forensic inpatient services is often considered necessary under the provisions of the Mental Health Act 1983 (as amended in 2007) to manage the risk to self and others (Lau, et al., 2020). In 1984, the Department of Health’s “Planning for the Future” strategy recommended the establishment of multidisciplinary psychiatric teams (MDT) comprising psychiatrists, psychiatric nurses, psychologists, social workers and occupational therapists to provide comprehensive treatment and care for individuals who present with mental health difficulties in order to improve the care provided (Haines et al., 2018). The MDT approach has become a standard practice in forensic service in the UK as a long-term management strategy (Haines et al., 2018).
Some of the short-term management strategies for challenging behaviours, namely self-harming behaviours, violence and aggression in in-patient services include restrictive practices. Restrictive practice “describes any intervention used in health and care settings which restricts a person from doing something they wish to do, or that coerces them into doing something they do not wish to do” (Mooney & Kanyeredzi, 2021, p. 1703). In the UK, this could include techniques such as physical, mechanical, and chemical restraint (sedation), seclusion, continuous observation, and restricted leave of the ward arrangements (NICE, 2015).
In UK, seclusion practice is defined in the Mental Health Act (MHA) code of practice as ‘the supervised confinement of a patient in a room, which may be locked. Its sole aim is to contain severely disturbed behaviour which is likely to cause harm to others’ (Department of Health, 2007, p. 122–123). The NICE guidelines (2015) further highlight that seclusion should last for the shortest time possible. However, the use of seclusion as a risk management strategy remains controversial (Meehan, et al., 2004). Data presented in 2021–2022 by NHS Digital (2022), reported 14, 466 seclusion interventions in in-patient services in England. In comparison to data from 2020 – 2021, (NHS Digital, 2021) that reported 14, 164 seclusion incidents, there was an increase in restrictive practice interventions in in-patient services.
Restrictive practice interventions in forensic inpatient settings can be perceived as potentially harmful to patients’ rehabilitation and could contribute to psychological distress and trauma in a population where prevalence of traumatic experiences is already high (Askew et al., 2019; Hansen et al., 2022). Some previous research has explored patients’ experiences of seclusion practices and one of the themes that emerged frequently was in relation to the physical features of a seclusion room, which was described by patients as an uncomfortable and unpleasant space (Haw, et al., 2011; Holmes, et al., 2015), claustrophobic (Hui, 2017), with and some patients comparing the seclusion rooms to a prison cell (Holmes et al, 2015), which was sometimes over used according to patients’ views (Pulsford et al., 2013).
Other studies that explored patients’ experiences with seclusion practices highlighted the re-occurring theme of negative feelings associated with seclusion. Some patients shared that they associated seclusion with boredom, punishment and feelings of distress (Tomlin, et al., 2019). Nevertheless, few studies demonstrated seclusion experiences were described by patients as beneficial due to the perceived opportunity to reflect on the incident(s) that led to being secluded (Haw et al. 2011; Keski-Valkama et al., 2010). It was also described as a space that allowed patients to feel more grounded and more able to manage their emotions/distress (Haw et al., 2011), increases their sense of control (Keski-Valkama et al., 2010), and seen as a protection for others of further harm (Holmes et al., 2015).
A large majority of the current research in this area focuses within general mental health settings as opposed to forensic psychiatric services. Despite the use of the seclusion remaining more prevalent within forensic services (Maguire et al, 2021). A study based on a forensic ward discovered that during seclusion, participants experienced difficult thoughts and emotions, and the physical environment was poorer than prison (Haw et al, 2011). This was supported by Holmes et al (2015) who summarised that for some patients, seclusion rooms were compared to a prison cell. These findings highlight that the physical space of seclusion itself represents a negative connotation and perhaps exacerbates their difficult their wellbeing during seclusion. This is important because it suggests that making improvements to the physical environment could improve the experience of seclusion for patients.
REC name
London - West London & GTAC Research Ethics Committee
REC reference
26/PR/0680
Date of REC Opinion
19 Jun 2026
REC opinion
Further Information Favourable Opinion