Hear My Voice: One Woman's Experience of Seclusion: A Case Study in a Secure Forensic Hospital

Seclusion use can cause harm and exacerbate existing trauma for the person secluded. Literature reporting on the woman's experience is sparse. However, it is understood that the experience of seclusion is negative, harmful, associated with feelings of fear and perceived as a punishment for behaviour. Women are under-represented in forensic hospital settings; therefore, their voices and experiences are rarely heard. This study aimed to explore the experience of seclusion for a woman admitted to a secure forensic hospital using a single case study approach. This study draws on findings from a prospective cohort study conducted on a women's unit within a secure forensic hospital. Demographic, clinical and seclusion-related data were collected from medical records. Data were summarised and described descriptively. Qualitative data were collected via a semi-structured interview to explore the woman's experience of seclusion. The case presented is a 38-year-old single, non-Indigenous woman, born in Australia. She was diagnosed with borderline and paranoid personality disorders, had an extensive history of trauma and experienced seclusion twice during her admission. Four themes were generated from qualitative data: defensive practice, torture and punishment, an embarrassing ordeal and hard lessons. Seclusion was perceived to be a punishment and a type of torture, resulting in feelings of shame and degradation. This case suggests that the negative experiences of seclusion may compound trauma for women with extensive histories of trauma. For women, increased therapeutic communication and engagement may work to address and avoid interpersonal conflict that may lead to seclusion. This engagement is important during and post the seclusion event, to build trust and mitigate negative effects of seclusion.