Psych patient’s 12 days in seclusion

A patient in the psychiatric unit at the Midland Regional Hospital in Portlaoise cried themselves to sleep during 12 days in seclusion.

According to a scathing inspection report by the Mental Health Commission, the unit used seclusion in some cases in a manner that was “ethically unacceptable and excessively coercive”.

One resident, who was interviewed by the inspection team stated that they had spent 12 days in seclusion.

“They stated that they did not come out of seclusion in that time, did not have a shower and that visitors were not allowed. They said the window blinds were never opened and they cried themselves to sleep,” read the report.

It was documented in the clinical file of another patient in seclusion that they “did not express remorse for earlier actions, to remain in seclusion”. The next entry, over two hours later, stated that the same patient “expressed remorse for earlier actions. Seclusion discontinued”.

In other cases, patients were described as “sullen in manner”; “demanding”; “unremorseful”; “continues to show no remorse for her actions”; “refusing to accept responsibility”.

“Expressing remorse for incidents that occurred during a period of severe mental illness must not be a requirement for ending seclusion. To do so is ethically unacceptable and excessively coercive,” said the MHC.

In another case, a resident in seclusion was described as “pleasant and engaging”. The treating consultant psychiatrist recommended ending seclusion and expressed “serious concern” about the length of time the patient was in seclusion. However, seclusion continued for a further 19 hours.

The patient had been in seclusion for more than 240 hours and stated to the psychiatrist that “even in jail I’d get out for exercise”.

In response, the Midland Regional Hospital said a policy on the use of seclusion has been updated; and that they have initiated a daily review of seclusion orders by a second consultant psychiatrist; and provided seclusion training for all staff.