Qualitative systematic literature review: the experience of being in seclusion for adults with mental health difficulties

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Mellow, A., Tickle, A. and Rennoldson, M. ORCID: 0000-0002-7131-8740, 2017. Qualitative systematic literature review: the experience of being in seclusion for adults with mental health difficulties. Mental Health Review Journal, 22 (1), pp. 1-15. ISSN 1361-9322

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Official URL: http://doi.org/10.1108/mhrj-04-2016-0007

Abstract

Purpose: To conduct a systematic search of the peer-reviewed qualitative literature investigating the lived experience of seclusion for adults with mental health difficulties, to appraise the quality of the existing literature and synthesise findings.

Background: Seclusion is a controversial intervention for the short-term management of unsafe behaviours in inpatient mental health services. There has been some sporadic interest in the service-users' experiences of this.

Design: Systematic literature review and meta-synthesis.

Data Sources: Databases MEDLINE, EMBASE, CINAHL and PSYCHINFO were searched in July 2015.

Review Methods: The JBI QARI tools for critical appraisal and data extraction were used to review papers and synthesise findings.

Findings: A small number of papers was found, which were of mixed quality.

Value: The existing research is limited in both quantity and quality. Although most participants from the existing research described seclusion as mostly negative with the potential for causing iatrogenic harm, some described more positive experiences, often in the context of compassionate interactions with staff.

Summary Statement:

Why is this research or review needed?
• The use of seclusion is common within mental health services but there is an absence of evidence for the purported theoretical rationale for its use.
• Studies of the experiences of individuals placed in seclusion are small in number, of mixed quality and with mixed findings.
• A systematic literature review and meta-synthesis of the existing qualitative literature investigating the lived experience of seclusion for adults with mental health difficulties was conducted, to synthesize the existing evidence base and make suggestions for future developments in research and practice.

What are the key findings?
• The existing research is limited both in quantity and quality.
• Despite the limitations of existing research, the evidence does not support the purported theoretical rationale for the therapeutic use of seclusion. This poses a significant challenge to a common practice within mental health settings.
• Seclusion has the potential to cause iatrogenic harm, particularly where interactions with nursing staff are not experienced as compassionate.
• The actions of nursing staff in implementing seclusion procedures may mitigate iatrogenic harm.
• Individuals who have experienced seclusion have suggestions for how to improve its use.

How should the findings be used to influence policy/practice/research/education?
• There is clearly scope for further, high quality research into people’s experiences of seclusion, particularly within the UK.
• The findings include concrete ways in which the practice of seclusion can be improved.
• Action research methods may offer a useful way of implementing and evaluating changes in practice.