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Night-time confinement and the practice of realistic medicine

  • Lindsay Thomson (a1) (a2) (a3)
Abstract
Summary

Night-time confinement is the practice of routinely locking patients in their rooms at night unless there is a contrary clinical indication. It is used in high-secure psychiatric hospitals. This article argues in favour of this practice on the basis of realistic medicine, an individual human rights based approach, the principles of mental health legislation in Scotland and England and cost effectiveness. This is not an academic debate. There is a real danger that those advocating against night-time confinement, if successful, will at best make little difference to the lives of our patients as they sleep, and at worst may hugely impoverish their lives because of reduced daytime activities.

Declaration of interest

L.T. is Medical Director at The State Hospital. Night-time confinement is used within this setting.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
Correspondence to Lindsay Thomson (l.d.g.thomson@ed.ac.uk)
References
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1Chief Medical Officer. Realistic Medicine Annual Report 2014-15. Scottish Government, 2016.
2UK Government. Mental Health (Care and Treatment) (Scotland) Act 2003. TSO, 2003 (https://www.legislation.gov.uk/asp/2003/13/contents).
3Braham, L, Heasley, J, Akiens, S. An evaluation of night time confinement in a high secure hospital. Ment Health Rev J 2012; 18(1): 2131.
4Chu, S, McNeil, K, Wright, K, Hague, A, Williams, T. The impact of a night confinement policy on patients in a UK high secure inpatient mental health service. J Forensic Pract 2015; 17(1): 2130.
5European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment. Report to the Government of the United Kingdom on its Visit to the United Kingdom Carried Out by the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) from 30 March to 12 April 2016. Council of Europe, 2017 (https://rm.coe.int/168070a773).
6NHS England. The High Security Psychiatric Services (Arrangements for Safety and Security) Directions 2013. NHS England, 2013 (https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/268545/HSH_Directions_Signed__2_.pdf).
7Department of Health. The Mental Health Act Code of Practice: Guiding Principles Chapter 22. TSO, 2015 (https://www.gov.uk/government/news/new-mental-health-act-code-of-practice).
8Scottish Human Rights Commission (SHRC). Human Rights in a Health Care Setting: Making it Work. An Evaluation of a Human Rights-Based Approach at The State Hospital. SHRC, 2009 (http://www.scottishhumanrights.com/media/1552/hrhcsfinalversion.pdf).
9UK Government. Response of the Government of the United Kingdom to the Report of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (CPT) on its Visit to the United Kingdom from 30 March to 12 April 2016. Council of Europe, 2018 (https://rm.coe.int/pdf/168077fa13).
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BJPsych Bulletin
  • ISSN: 2056-4694
  • EISSN: 2056-4708
  • URL: /core/journals/bjpsych-bulletin
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Night-time confinement and the practice of realistic medicine

  • Lindsay Thomson (a1) (a2) (a3)
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