The use of seclusion in secure forensic environments: An investigation of factors influencing nurses attitudes

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Peter Thomas Sandy

University of South Africa, South Africa

: Int J Ment Health Psychiatry

Abstract

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Background: Secure forensic mental health services always need interventions to manage aggressive and violent behaviors. Seclusion is one of a number of interventions used for managing these behaviors in these settings. Service user’s experiences with seclusion are mainly negative with feelings of punishment and threat being the most commonly reported reactions. Some nurses regard seclusion as antitherapeutic, while others consider it an effective intervention. Despite these discrepancies, nurses continue to support the practice of seclusion. Objective: To investigate factors that might influence attitudes of nurses working in a secure forensic mental health setting towards the use of seclusion. Methods: This study utilized an analytic cross-sectional survey design to investigate and explain associations between the use of seclusion and attitudes towards it. Data were collected between October and December of 2014 using a self-administered questionnaire: Staff attitudes toward seclusion. Eighty-eight nurses (N=88) completed the questionnaires. The data were analyzed using descriptive statistics (percentages and frequency distributions) and inferential statistics, specifically spearman’s rank correlation coefficients, chisquare and Mann-Whitney tests. Results: The reasons for the use of seclusion noted in this study were consistent with Mason’s (1993) treatment, containment and punishment framework. The study revealed several significant but mostly negative associations between attitudes of nurses toward the use of seclusion and factors, such as age, sex, post, experience, and registered practice. Positive and significant associations were also found between attitude variables and grades or rank of nurses. Conclusion: The findings of this study offer insight into nurses’ attitudes toward the use of seclusion. They may serve as a useful resource for the development of guidelines, policies and training program for enhancing positive attitudes towards seclusion.

Biography

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Peter Thomas Sandy is presently an Associate Professor at the University of South Africa, Department of Health Studies. He is a Mental Health Practitioner and Health Research Psychologist who has worked in the United Kingdom with a wide range of clinical presentations of people with mental health difficulties and learning disabilities. As a Clinical Lead, he actively supported people with drug and alcohol problems, mental contributors 298 health difficulties and self-harming behaviors using specific counseling styles like motivational interviewing. He is interested in drug and alcohol use among vulnerable populations, such as women, homeless and people with mental health and learning disability problems. From a broader perspective, he has huge interest in attitude and behavior change, and has conducted funded research related to these areas. For example, he conducted research on attitudes of mental workers on people who self-harm in large mental health institutions in England that resulted in the development of the Self-harm Explanatory Model. As an academic, he has worked in the England as a Principal Lecturer (Associate Professor) at Buckinghamshire University and developed and led a range of training programs for mental health practitioners in both generic and forensic settings. He earned his Doctoral degree (PhD) from Brunel University, England, United Kingdom. His thesis focused on a very controversial area of mental health practice, “Application of Harm Minimization Approach to People who Self-Mutilate”.

Email: sandypt@unisa.ac.za