Mental health professionals' perceptions and attitudes towards seclusion: The ambivalent relationship between safety and therapeutic considerations.

Background: Frequency of seclusion in acute psychiatric units varies greatly worldwide. In Switzerland, its use is authorised under strict conditions. However, this coercive measure is not implemented in every psychiatric hospital in the country. The use of coercion is associated with a number of patient characteristics as well as organisational, contextual and professional's aspects. Nevertheless, the role of these factors remain inconsistent across studies and different coercive measures are often studied together. Hence, the aim of this study was to assess mental health professionals' perceptions and attitudes towards seclusion according to their experience with this type of measure and their personal and professional background.

Method: Nurses and physicians working in acute adult and geriatric psychiatric units in the Swiss Cantons of Vaud and Valais were invited to participate to an online survey exploring their socio-demographic characteristics, professional background, current position and activity, as well as their perceptions and attitudes towards seclusion. Exploratory Structural Equation Modelling (ESEM) was then used to determine the structure of the participants perceptions and attitudes towards seclusion to identify which socio-demographic and professionals' aspects could predict their underlying dimensions.

Results: 116 mental health professionals agreed to participate in the study. A majority considered that seclusion had a therapeutic impact, while believing that it could also have negative effects or be dangerous for the patient. The majority also thought that seclusion increased the general feeling of safety. Lastly, a substantial proportion felt that the Swiss legal framework regulating seclusion was not sufficiently clear. Mental health professionals' perceptions and attitudes towards seclusion could be described by four dimensions: "Negative consequences", "Safety", "Legitimacy/legal aspect of seclusion" and "Organisational aspects". Analyses revealed a tendency to normalize seclusion as its use increases.

Conclusion: Seclusion poses complex challenges for mental health professionals. The competent authorities should therefore provide careful guidance to help them maintain a high level of quality of care in the use of this coercive measure.