Tom is a 45 yr old man who has, due to repeated offending, been in a high level secure mental health unit for the past 10 years.
Tom has a diagnosis of Paranoid Schizophrenia. Medication and therapeutic apporaches have failed to reduce his delusions and paranoia and this results in frequent violent and aggressive outbursts against certain members of staff. Tom spends some of his time in seclusion, this intervention is claimed to prevent the risk of harm to others.
Tom verbalises that he feels aggressive when he hears loud voices or others prolong their eye contact with him, which he finds intimidating. He also becomes very withdrawn and depressed when he is in seclusion, will often resort to head-banging, as a protest and often refuses to eat or drink when he finds himself is in this situation. As a result, Tom has lost considerable weight over the last 6 months.
You are a care worker on this busy, short- staffed secure unit.
You have noticed that when a certain member of staff is on duty, Tom tends to be put into seclusion more often than when this member of staff is not on duty. Tom does become aggressive in these instances. The member of staff, Tony, a Registered Mental Health Nurse, who qualified 6 months ago, is regularly put in charge of the shift. Tony has a loud authorative voice and often is seen 'squaring up to Tom' and maintaining eye contact with him, when he feels that Tom is 'about to kick off'. This results in aggressive behaviour from Tom who ususally will lash out at Tony. The result is that Tom is put into seclusion for the rest of the shift to 'protect the the staff and patients from potential or actual harm'. Tony also states that 'he doesnt have time for Tom's games and besides it will free up our time to take care of the other patients who are high dependancy.'
What do you think is 'appropriate' in this situation ?
It is proposed that it is appropriate to place Tom into seclusion when he lashes out physically at Tony, especially as the unit is busy and short-staffed.