Seclusion in the context of recovery-oriented practice: the perspectives and experiences of staff and service users

Seclusion is used in increasingly recovery-oriented adult mental health services. No studies have specifically explored psychologists’ perspectives and experiences of seclusion or the perspectives and experiences of staff and service users on seclusion in the context of recovery-oriented practice. This thesis aimed to address these gaps. A systematic review of 27 studies explored the extent to which principles of recovery were evident in the perspectives and experiences of staff and service users on seclusion. Limited findings of seclusion being consistent with recovery principles were consistently accompanied by greater evidence that seclusion was perceived as directly opposing these. Service user perceptions placed seclusion and recovery at greater odds than staff perceptions. A qualitative hermeneutic phenomenological study adopting a social constructivist perspective was conducted. This explored the roles of Irish psychologists in the process of seclusion, their perspectives on seclusion, its use in recovery-oriented practice and related professional practice issues that may arise. Semi-structured interviews with 17 psychologists were analysed using reflexive thematic analysis. Twenty-four themes clustered within four overarching themes were identified. Seclusion was perceived as a peripheral topic within their work and Irish psychology more broadly. Seclusion was considered problematic and largely inconsistent with recovery, but occasionally necessary at present. Participants perceived that systemic factors influenced practice in relation to the topic, including often limited multi-disciplinary shared care and recovery-orientation in services. Overall the findings highlight the importance of reflective practice and point to changes to partially reconcile seclusion and recovery. They underscore the need to openly acknowledge the reality of conflicting priorities that cannot be easily reconciled (e.g. safety v rights, care v control) and the importance of conscientiously balancing needs to ensure ethical practice. The findings suggest that psychologists are well-suited to participate in local and national discussions on the complexities of using seclusion in recovery-oriented practice.