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by Dr Gaurav Sharma,
Dr David Reiss and Jonathon Lynch
Last updated: August 2019
Seclusion is a method used by mental health
teams around the world to manage aggressive and disturbed behaviour
in psychiatric patients, in situations where there is an immediate
risk of harm to others.
It is particularly important when hospital care is provided to
the most unwell or highest-risk patient groups, such as those
requiring forensic or similarly secure environments. Use of
seclusion can be controversial; therefore we have a huge
responsibility as psychiatric professionals to ensure that its use
This module highlights guidance from the 2015 version of the
Mental Health Act 1983 Code of Practice. It covers the definition
of seclusion, the circumstances in which seclusion might be
considered as a last resort, and situations in which it should not
be used. The module looks at the features of a seclusion area and
the practicalities of secluding a patient. It also lists prevention
and safety-planning measures for minimising the use of seclusion
where possible, and provides two clinical vignettes.
When someone has been secluded, a series of review processes
should be initiated. The module outlines what should be discussed
in a pre-review meeting and what should be considered in the
patient’s seclusion care plan. It then covers
the seclusion review and what should happen afterwards.
Learning is supported by a series of video clips showing a
seclusion scenario. The videos include a pre-review meeting, the
review in the seclusion room, and the post-review meeting in which
the team decides whether to continue or terminate the
The module also explores the use of seclusion for longer
periods, special considerations for patients with particular needs,
and the legal implications of secluding a patient.
If you like this module, you may also be
Rapid tranquillisation of the acutely disturbed
patient by Dr Aileen O’Brien, Caroline Parker and Jules
Risk assessment and management of violence in
general adult psychiatry by Dr Fiona Toal, Professor
Paul Mullen and Professor James Ogloff
Managing challenging behaviour in mental health
in-patient units by Dr Dominic Beer and Mr Anthony Davis
Book from RCPsych Publications:
Prevention and Management of Violence: Guidance for Mental
Download take-home notes to print and
Newton-Howes G (2013) Use of seclusion for managing
behavioural disturbance in patients. BJPsych
Advances, 19: 422–428. [abstract]
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