1. Seclusion: treatment or punishment?

    Dear Editor,

    As a Mental Health Nurse of some 30 years practice I wish to compliment Helen Kirkpatrick on her insightful article regarding the primarily counter-therapeutic effects seclusion has in the overall treatment of the mentally ill person.

    As an RN working in a state run facility I can personally attest to a horrible treatment plan that was referred to as "Voluntary Open Quiet Room". During the course of this treatment some of my patients were made to stay in a seclusion room 'voluntarily' for up to a year at a time. If the patient came out of the voluntary quiet room I and the other nurses were told to call the doctor to obtain an order for either 4-points or locked door seclusion.

    My patients felt coerced and did not like this treatment plan. After pleading with the administration on behalf of my patients to stop this "illegal" treatment plan I had little choice but to empower my patients. I contacted legal aid and was able to obtain a mental health lawyer who my patients were able to personally communicate with on their own behalf.

    Based on the patients complaints the lawyer in part made the following summation to convince the Department of Mental Health to stop this treatment plan:

    1. Isolation inhibited the patients' access to treatment and may even worsen their mental health.

    2. The need to keep a patient safe should not require the patient to forfeit fundamental aspect of care, including regular treatment, contact with patients and staff and dignity. In fact, such forfeitures themselves might make a patient to self-injure.

    And so perhaps patients are right even legally in viewing that this and similar plans as described in Ms Kirkpatrick article is not only undesirable to patients but may prove to be a criminal act of punishment against their person as well.

    Warm regards,
    Thomas M Fraser RN

    No competing financial interest declared.

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