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"The word confinement is shackled with connotations of punishment and imprisonment, so it is hard to feel anything but aversion on learning that patients in high secure settings are routinely locked in their rooms throughout the night. It just feels antithetical to the caring professions. But confinement also alludes to the time after childbirth during which a new mother is supported and nurtured. These differing senses of the word are at play in this collection of articles that present opposing views on the practice; is night-time confinement an act of care or a punishment. I thank the authors for their thoughtful and provoking papers and also our Associate Editor Catherine Penny for commissioning the series. Lock yourself away and read them tonight. Then tell us what you think."
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.
Night-time confinement, locking patients in their bedrooms overnight, is practiced within high-secure hospitals in the UK. This article provides context, sets out the history and reviews the ethical and pragmatic issues at stake. Thought is given to the future, where we appear to be moving toward a different approach.
Declaration of interest
E.S. is a consultant forensic psychiatrist at Ashworth Hospital. All his patients are confined at night. He represents the Royal College of Psychiatrists Forensic Faculty at the National Oversight Group, which is the strategic advisory body providing assurance to NHS England regarding the commissioning and provision of high-secure services.
Night-time confinement, currently imposed as a blanket restriction on all patients on wards in UK high secure hospitals, constitutes an arbitrary restriction of liberty, not being based on any therapeutic purpose for those so restricted, nor serving a need for the protection of others. Its imposition constitutes a form of ‘degrading’ treatment as well as an unjustified restriction of ‘residual’ liberty. Persons who are vulnerable, especially those who are involuntarily detained as in this case, are particularly at risk of suffering human rights abuses. A compelling case can be made, based on ethics, law and accepted practice standards, for ruling out night-time confinement as an acceptable measure.