Open-Area Seclusion in the Long-Term Treatment of Aggressive and Disruptive Psychotic Patients, an Introduction to a Ward Procedure

Abstract

The clinical rationale and procedure of “open-area seclusion” as a treatment modality with psychotic patients is presented. This standard procedure was originally introduced as an alternative to arbitrary measures in response to aggressive and disruptive behavior. The seclusion area is locked, but the patient is never locked up alone in any single room. The method of open-area seclusion is composed of four overlapping phases: (1) assisting the patient to the seclusion area, (2) time for a “calming down” process, (3) debriefing, and (4) reintegration. Verbal confrontation is central in enhancing the secluded patient's reality-testing, for reinforcing responsibility for one's own behavior, and for encouraging alternative problem-solving. A step-by-step description of the procedure of open-area seclusion is presented and illustrated by a case history.