Despite the elimination of seclusion in mental health care being a government policy for over a decade, it is still happening. Here’s one patient’s story.

Early this year, a man in his early 20s was taken to the emergency department by his mother and father. A stressful period had resurfaced deep trauma, and the man had been distressed and not sleeping properly for about three weeks. Now, he was experiencing psychosis for the first time. Initial care at the hospital seemed good – the man, let’s call him Jack, was given medication that calmed him and then moved to a bed in a specialist hospital. “I had so much faith,” says his mum. But the next day, delusions led him to try to “escape” the hospital. That led to him being put in a seclusion room continuously for eight days and nights. 

In New Zealand’s mental health and addiction services, seclusion (sometimes referred to as solitary confinement), is used as a last resort for people who are acutely distressed. It’s widely understood to be traumatic and harmful for the patient, whānau, visitors and health workers. A project to eliminate its use, Zero seclusion: Safety and dignity for all, has been under way since 2019. Yet progress was initially slow and uneven across different health board districts. In the 2022/23 financial year, 942 people were secluded by inpatient mental health services in New Zealand. Most were put in seclusion more than once. A paper published earlier this year shows some progress – since 2018/19, the rate of seclusion in adult, non-forensic inpatient mental health units has been reduced by 33%.

This is what those eight days of seclusion were like for Jack inside that room, and for his parents outside, who were fighting to get him out.

Jack*

All I remember about being put in the room is being dragged in by both my arms by security. That’s all I remember. I was really, really not well, I feel like I wasn’t entirely conscious of what was going on. I wasn’t in control of myself, I don’t think I really took everything in. I’m pretty sure I was trying to get out when they opened the door, and then they pushed me back.

I look at pictures of prison cells and stuff, it’s kind of the same. There was a metal toilet, kind of like a prison one, I’d say. A shower, you’d press the button and it would only stay on for like 10 seconds. There was a little alcove that had the toilet and the shower in it, but there was no door. It was pretty much in the same room. And then for the bed, it wasn’t even a bed, it was a high jump mattress on the floor – you know those blue mattresses they use for athletics? One of those. It wasn’t comfortable. It had some really thin sheets, but then they took them all away. I think it was because I might strangle myself with some or something. They took everything away, and it was just the blue mattress in the end.

Mum

He’s a real gentle kid, he’s the type of kid that if there was a bee or a fly in the house, he would take them out. It’s not in his DNA to be an aggressive person. When they said he was going into seclusion, we assumed that meant for a couple of hours. That he would be with a nice nurse, and just sit and have a chair until he was feeling calm and comfortable.

Dad

There was a very, very short conversation about seclusion – the nurses informed us, as we were leaving, “We think we’re going to have to put him into isolation.” There wasn’t a sit-down about what that means. It wasn’t a conversation about when, timelines or anything. I assumed it meant to keep him safe for the moment, for a short time.

Jack

I couldn’t tell you how many days I was in there. There was an analogue clock on the wall behind safety glass, but it didn’t mean anything to me. They never turned the lights off. At night time the lights were on. I could hear a generator, or something humming, for the entire time. It never stopped.

There was a little space in the wall where the nurses could look through a little window. There was always a nurse outside, but they didn’t have conversations with me. I don’t think I tried, though. It felt like I just left there alone. 

On the other wall there was a big window, but outside the window there was a wall. There were some flowers, but then just a wall, so I didn’t know where I was, especially when I was psychotic, I didn’t know. I just had no idea. I think seeing a wall outside made things seem even worse. The window didn’t open and was made from some sort of plastic.

I’m pretty sure each day they gave me a change of clothes – my own clothes – but there was nothing else, just the mattress. I just lay there. I lay there like making things up in my brain that weren’t real. I know part of psychosis is having hallucinations but the only time I actually had hallucinations was when I was in there. I didn’t hallucinate when I was out of there at all. I think maybe my brain was trying to make up for having nothing.

Mum

I brought some items from home for him: a pillow, an old toy of his – a little hippo, just a tiny one – so he would have something familiar from home. We found out at the end of those eight days that no, they had never been in there with him. 

They told us that he was the most unwell person in the hospital, so I get that, but then how do we manage that? I would have been very happy to sleep next to him, and I would have felt safe with the right medications to keep him safe. He didn’t see a doctor while he was in there, just a nurse practitioner. He also had not seen a psychiatrist, because they were understaffed, so the nurse practitioner was stepping in for the psychiatrist.

Jack

When they brought food, I swear they acted like they were really scared of me. They’d open the door just a little bit and slide my food over the floor. I only remember getting breakfast, or the food was always breakfast food – Weet-bix or a ham sandwich and sometimes Milo. I don’t eat ham, and they kept giving me ham sandwiches. That’s what I remember. The ham sandwich would sit there for a day or two before they took it out. I don’t remember getting water, and I don’t think I brushed my teeth for the entire time.

One of the nurses would have my mum on the phone. She would hold it through the crack in the door, and I’d speak through it. I remember her asking where I was, and me saying, “I’m in a room.” I don’t remember much else. I don’t know why she asked me that. I don’t know if she knew where I was. It’s weird how they didn’t let Mum or Dad just come to the door or something. Maybe it’s because it would be too embarrassing for them to let parents see what they’re doing. I think Mum and Dad probably don’t realise how bad it was. They probably picture the room as a bit nicer than it was.

Mum

I would ring every night because they wouldn’t let us in to visit him. They said it was a breach of privacy for other patients. So I would ring and I would say, “Where is he? Can you tell me why he’s still in there?” They would say, “Oh, because he’s kicking the door and he’s wanting to get out, and he keeps saying, ‘I want to get out’.”

They weren’t going to let me even talk to him and I said, “Look, what about his human rights?” So they said to me, “OK, well we can open the door and slide the phone to him.” That’s what they would do with his food, and that is what they were to do with the phone as well. All he wanted to do was get out of there. He would say, “Yes, I’m kicking the doors, Mum, because I can’t get out. How do I get out of this place?”

They didn’t want to let him out because he was trying to get out. What would you do if you were stuck in a room for eight days? What would a dog do or a cat do if they were stuck in a room for eight days? We had the time and the tools to be able to fight for him to get out.

Dad

It was a hard process in order to get Jack out of seclusion. We banged on, turned up and rang and rang for days and days. We had a meeting around day four, where we got very cross about where he was. I asked for days to be able to sleep in seclusion with him. They told me that I couldn’t do that, and the reason I couldn’t do that was for my safety, the safety of the staff and the privacy of the other patients. 

In the end, when they agreed to move him out to the high need ward, I stayed with him there. I used up annual leave, my sick leave, and then ended up just lying, and working from hospital and home and all that stuff in order to get through, to keep him safe. To be fair, my own health plummeted as well. We both were destroyed through this process.

Jack

I do feel like I was treated kind of like an animal in a cage. I remember kicking the door. It was locked with a chain and an old school padlock – not even a normal door lock – so when I kicked the door the chain would rattle.

To give me medication, sometimes they would come in with four or five people. I don’t know if they were doctors or nurses, I actually have no idea, but they were never women. 

There were other seclusion rooms, right next to me. I’d hear other people trying to escape, or just screaming. It was a corridor of probably three or four rooms with people trapped in them, and everyone was trying to get out.