Psychiatric seclusion: Patient and staff experience - A mixed-methods study

Patients and staff frequently differ in how they interpret the meaning and impact of psychiatric seclusion, yet few studies have directly compared their perspectives or examined the influence of gender, perceived staff availability, and seclusion duration. This study aimed to compare patients' and staff's emotional experiences of seclusion and identify factors associated with its perceived benefit and psychological impact.

This mixed-methods study included 39 inpatients from an acute psychiatric unit who had experienced seclusion and the staff involved in their care. Semi-structured interviews were conducted shortly after the end of seclusion, and standardised assessments measured anxiety, depression, and acute stress among patients. Quantitative analyses used non-parametric tests and correlation analyses, while qualitative data were examined lexically using IRaMuTeQ software. Reporting followed the STROBE and COREQ guidelines.

Patients reported significantly lower perceived benefit than staff (P<0.001). Female patients showed higher anxiety (P=0.039), depression (P=0.005), and acute stress (P<0.001). Greater inaccuracy in time estimation was associated with longer seclusion episodes (P<0.001), and perceived staff availability correlated positively with the perceived benefit of seclusion (P=0.0095).

The consistent gap between patient and staff perceptions, gender-related vulnerability, the association between perceived relational availability and perceived benefit, and distortions in time perception suggest the potential value of structured post-seclusion debriefings and trauma-informed approaches to foster recovery and strengthen the therapeutic alliance.