Does isolation reduce violent behavior among psychiatric inpatients?

By Kevin R. Betts

The Joint Commission, an independent health care oversight group, recently expressed alarm over violence in U.S. hospitals. Russell L. Colling, a consultant who advised the Joint Commission said, “The reality is, there is violence every day in the emergency department.” On inpatient units in psychiatric hospitals, violent behavior among patients is often met with forced isolation. A primary goal of isolating these patients is to ensure their safety, as well as that of other patients and staff. However, isolation is also thought by many to act as a deterrent for potential future acts of violence. Having been directly involved in this process as a mental health technician, I often pondered the effectiveness of isolation as a way to combat violent behavior among patients.

Perhaps counterintuitively, research on social ostracism suggests that isolation may promote later aggressive acts (Williams, 2007). In order to understand why this may be the case, imagine yourself in the position of a patient involuntarily committed to an inpatient unit at a local psychiatric hospital. Disagreeing with your involuntary admission, you verbally express your anger to the staff. Told that you may not leave, you become even angrier, perhaps trying to access locked doors. You feel an utter lack of control over your situation. Making matters worse, the staff expresses concern that you may become violent as a result of your distress and “for your safety,” escorts you to a locked room so that “you may reflect on your acting out behavior.” You are in isolation. Your anger further increases and you find yourself behaving in ways you could not previously imagine, yelling “let me out” and banging on the only door in a windowless room. You think to yourself, “They will regret this once they let me out of here.” What you (and many other patients placed in similar situations) are experiencing is an impaired sense of belonging, self-esteem, control, and meaningful existence―direct consequences associated with social ostracism (Williams, 2007). In the eyes of an isolated patient, these needs may wrongly be perceived as restorable through aggressive means.

If isolation can promote violent behavior, what should be done to combat violence among distressed psychiatric inpatients? Solutions that prevent violent behavior in the first place may be most successful. Listening to patient complaints in a timely manner is essential. Empathizing with these complaints, helping patients manage their distress, and ensuring patients that their distress is temporary should also be effective.

Read more: on the rise at U.S. health care centers (Businessweek), K.D. (2007). Ostracism: The kiss of social death. Social and Personality Psychology Compass, 1, 236-347.

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One response to “Does isolation reduce violent behavior among psychiatric inpatients?

  1. well well… isolation, that should not even exist! It shouldn’t be part of a supose-to-be-treatment! It’s true, someone who is put in an isolation room because of anger or like you said “an utter lack of control over your situation” and Disagree with your situation. Being lock while you never wanted to be, but no choice because the police brought you to the hospital, and they said “you NEED to go there”…. there ain’t a choice in there… you pissed off, show you’re anger to the staff than, damn.. they put you in isolation, and if you dont want to get in, they’ll put you in with “exessive force”… IT IS NOT RIGHT. and it needs to change.

    Isolation doesnt help to cool down the anger of a patient.. it puts his anger even bigger than he could never imagine it could be… Than after, you do things you would never thought you would do… unbelievable! I say they should BAN isolation in psychiatric center… and talk to the patients instead to lock and tie ’em up! That’s how i whised it could’ve be. Just talk to the patient, ask what’s wrong, say the truth, and do something to change what’s wrong, they need to CARE. But they DON’T care right now. They are pay to sit on there fucki** ass all day, giving pills, and doing nothing to help…. damn… i just can’t believe how it is… but it is the way it is, the reality… and it suck! It NEEDS to CHANGE!

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