The physical environment of inpatient psychiatric units can impact patients’ levels of aggression and agitation and therefore, lead to increases in the use of restrictive interventions and seclusion. Many studies have focussed on the impact of the design of the ward on patients’ wellbeing, experiences, and recovery. However, studies investigating the impact of the environment and experiences of seclusion on the experiences of escalation and de-escalation of patients is scarce. In this presentation, we present some preliminary findings relating to how the environment and experiences of restrictive interventions and seclusion impact patient and staff experiences of escalation and de-escalation.
A qualitative study was used. Data was gathered through semi-structured interviews using photo-production and photo-elicitation with staff and patients within an intensive care psychiatric unit within the United Kingdom. We will explore three themes in the presentation, including ‘Not All Spaces Are Perceived Equally…’ which included 2 subthemes exploring the features of the environment that are conductive to de-escalation and the unhelpful qualities of the environment. The second, ‘The Seclusion Room Acts as an Antithesis of Its Purpose’ explore a paradox between the need and use of seclusion and the negative impacts and associations of the seclusion room. The third , ‘Relating and Alienating’ includes two subthemes and explores how the relationship between staff and patients changes after seclusion and the impact of the time of the day on patient and staff relations. Running through this analysis is attention to the master theme of psychological safety and how environments might be designed to simultaneously prioritise both psychological and physical safety.