Alone Alone All All Alone

Don’t mind the momentary change in direction, we’re taking a little detour from my last post. We will go back there but I want to talk about the reality of the practice of seclusion in 2011. “Seclusion is the placing of a person at any time and for any duration, alone in an area where s/he cannot freely exit.

Seclusion, what it can mean

In addition to containment and isolation, seclusion is usually accompanied by a reduction of sensory input. The room is bare, often limited to blank windowless walls, fluorescent lights, a mattress and sometimes a toilet. Time spent in seclusion can vary from minutes to hours and even days.”

Sound Orwellian? It is. And in New Zealand, in 2011 I’m appalled by its continued use despite a knowledge of more effective and humane practices. Worse still, it’s a common and continuing practice within mental health acute units throughout New Zealand.

“I think it shows a low regard for another human life to lock someone up on their own. There are proven ways of dealing with situations without coercion, so why do it?” – Mary O’Hagan, a New Zealand Mental Health Commissioner.

Seclusion (also referred to as sectioning by patients) involves placing a person on their own in a bare room or in Kate’s case, in the company of others around her within an acute mental health inpatient unit. The ‘others’ I refer to here are patients suffering from acute mental conditions.

Personally, I think the practice of seclusion as it relates to Kate seems completely at odds with any kind of recovery or therapeutic model of mental health care designed to bolster her physical, emotional or mental well-being!

She has now spent the last three days in seclusion, her time there has been continuous. It struck me that if you scratched the surface of Te Whare Ahuru’s ‘wellness’ philosophy, all the love, peace and mung beans goes out the window and it’s historical seclusion practices appear just below the surface. Organisationally, it reverts to type but that says more to me about the people than it does about the system. People doing this to other people.

Prolonged Seclusion

So like Rangipapa, we ought to be circumspect in our beliefs about what Te Whare Ahuru says about itself. Decisions made in relation to Kate have made a significant departure from the model that was said to have influenced its practices. Why is that? Yet that being so, we should be grateful for Kate’s sake for the legal constraints placed on it as an institution in s 5 of Seclusion under the Mental Health (Compulsory Assessment and Treatment) Act 1992 relating to ‘Prolonged Seclusion’.

I like to think 5.1 is something of a safety valve. It states that, “If over the course of one admission, the cumulative hours of seclusion exceed 24 hours in a four-week period, reassessment in the form of a case management conference should occur.

For the record, Kate’s been there less than a fortnight. The point continues, stating that the “cumulative hours of seclusion should NOT include hospital standing orders of seclusion or night seclusion.”

I don’t know about you but to me, being in seclusion for more than 24 hours constitutes ‘standing orders’ given the constancy of it and the fact that she isn’t released back into her own room at night is contrary to the fact that night seclusion shouldn’t occur. This is NOT bad luck for one person. It’s malicious. Intent to do what I wonder? Push her over the edge?

Punishment Overkill?

So what did Kate do? She isn’t quite sure but her explanation to me this morning was she had been late back into Te Whare Ahuru on Thursday 26 May 2011. She’d left at approximately 12.30pm in the afternoon and returned before 5pm. Her return was confirmed to me by TP who drove her back to the unit.

She had left a note for staff on her bed advising she was going out but that she would be back before dinner. She was true to her word. She returned before 5pm. It puzzles me then that she’s done 3 days in seclusion for lateness. Personally, I find that an excessive punishment, don’t you?

“Reasons given for using seclusion most commonly refer to therapeutic value and safety. However, there is no evidence-based research that supports the idea that seclusion is therapeutic. Rather than improving safety, seclusion has been shown to cause not only physical but also emotional and mental harm.

Seclusion is not meant to be used as a tool of punishment or coercion, although this is how it is often experienced by people in the Unit.” If I was in Kate’s shoes, I might be experiencing and certainly interpreting this current stint in seclusion in exactly that way!

How else could Te Whare Ahuru staff explain such a harsh response? Maybe we should view Kate’s treatment as part of the reason a secret government inquiry was undertaken into treatment blunders and leadership problems within Hutt Valley’s Mental Health Services. None of it is any consolation for Kate though. They’re an albatross around her neck.

FAST FORWARD to 2018
1. Inside Ashley Peacock’s new home after release from mental health unit 2. RNZ: Inside New Zealand’s Newest Seclusion Rooms

RELATED CONTENT
1. PDF: Seclusion Management in an Acute In-Patient Unit by Barbara Joy Mosley.

RELATED POSTS
1. Systems that take the Kate 2. Model Citizen: A Piece of Kate 3. A Twist of Kate: The Castaway 4. Throwing Out the Lifelines 5. An Anchor in the Social World 6. Rights of Passage 7. Katherine 8. Ships in the Night 9. Alone Alone All All Alone