Dr. Lorcan Martin:

Some 73% of centres may have used it, but using restrictive practices on one person, once, puts a centre on that list. There are thousands of admissions every year and restrictive practices are not used that frequently. As my colleagues pointed out earlier, it is an absolute last resort. It is strictly controlled by the codes of practice from the Mental Health Commission, to which we all adhere. We would be found non-compliant if there was as much as one date out of place on the seclusion register. The standards of governance have improved substantially over the last years. There are now specific seclusion-related care plans, so it is not simply a question of it being written in a chart or register book.

Using seclusion as an example, patients would be in seclusion for the shortest period possible. They get regular reviews. If they go in for an hour, a nurse will watch them full-time for an hour and for 15 minutes thereafter. They have regular medical reviews to make sure that their dignity is maintained in accordance with the codes of practice. It is often a more humane way of dealing with people who are incredibly distressed and agitated and are putting themselves at risk. Having a quiet time-out area can be extremely useful. Seclusion may be more appropriate than restraint for some people. One example is people who may have been sexually abused, for whom the notion of physical restraint or being held down could be extremely triggering or traumatic. Using a time-out area, which is locked for their own safety and the safety of others, may be the way to go.

The notion of zero restraint and zero seclusion is unrealistic when managing seriously ill patients. We should aim for the absolute minimum use of seclusion and restraint and every other avenue should be tried before it is used. All the care plans that we use talk about de-escalation techniques, use of oral medication and so on before one gets to the last resort. Zero restraint and zero seclusion is not practical or clinically humane. However, we should aim for minimal use of them and preferably try everything else.