Legal and ethical aspects of seclusion: an Australian perspective

The debate about the appropriateness of seclusion as a nursing practice in inpatient settings in the 21st century continues, with powerful and often emotive arguments from those who view it as an anachronistic and punitive form of ward management, and from others who see it as a useful emergency measure to protect individuals from imminent harm. This is the first paper, however, to focus on legal and ethical issues in relation to the use of seclusion, with policies and practices in Australian psychiatric institutions viewed within the context of worldwide trends. The interplay of ethical principles and international mental health law has encouraged a move towards the provision of care and treatment of the disturbed psychiatric patient within the least restrictive environment, supposedly reducing the potential for the inappropriate use of control mechanisms. Nevertheless, current legislation can be seen to preserve the status quo because it legitimizes seclusion as an acceptable nursing practice, albeit within given parameters, thereby defusing the imperative to promote the reduction and abolition of psychiatric control mechanisms and seek new possibilities in mental health care.