Women with Learning Disabilities in a Secure Hospital Setting and their Experiences of Seclusion: Adopting a Feminist Case Study Approach

Jones, Helen (2023) Women with Learning Disabilities in a Secure Hospital Setting and their Experiences of Seclusion: Adopting a Feminist Case Study Approach. Doctoral thesis, Birmingham City University.

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Abstract

Aims
• To find out how women with learning disabilities within secure mental health hospital settings in the United Kingdom viewed their experiences of seclusion. It set out to capture the unique experiences of women with learning disabilities by exploring and analysing their own accounts.
• To inform and contribute to the current policy drive and debate regarding the use of restrictive practices across mental health and learning disability services and include the views of the participants themselves.

Methodology and Methods
The study has been designed within a feminist framework which has shaped and guided the way in which the literature review was conducted and then also the methodological design and data analysis.

This study adopted a qualitative Case Study methodology that allowed different sources of data to be collected and analysed. Semi-structured interviews were used to gather data from fifteen women in two different medium and low secure hospital settings. These data were triangulated with case notes, observations and discussions with care staff. Data were analysed thematically.

Findings
Thematic analysis identified three themes which showed gender nuances in seclusion use for women. The themes were:
1. Cultural construction and language
2. This is me – Self-perception and what defines the female and learning disability experience
3. Hierarchy, support and power – the importance of staff

Key findings included:
• A-typical and multifactorial nature of seclusion – differing perceptions and perspectives on the reasons seclusion is implemented
• The importance of language and its misrepresentation of perception. Cultural language embodied by the institution is also adopted and used by the women to express themselves and to describe their experiences. This is reflective of the institution but not necessarily reflective of the way in which these women themselves feel.
• The importance that the women attach to having the support of familiar, skilled staff. For the seclusion experience to be and to remain a therapeutic experience then familiar staff need to be utilised with significant therapeutic skills.

Discussion and Conclusion
The findings of this study offer a unique contribution to knowledge by providing insights of the experiences of seclusion from the perspective of women with a learning disability. Use of a feminist lens brings to the fore the role of language and power. This leads us to consider how our current policy, legislation and guidance serves the women and the way in which they experience seclusion. Recommendations for practice change are offered based on the narrative of the women, the female clinical presentation and viewing our current debate on the use of seclusion through the experiences of these individuals.

Implications for Practice
• The skills and consistency of staff support is vital for individuals experiencing seclusion. It is therefore important to ensure that this forms part of care planning, risk assessment for seclusion and other associated restrictive practices.
• Staff need to understand the perception of seclusion and experience of seclusion of the individual person. For some the need to feel safe and supported around de-escalation is vital.
• Staff need to understand that the person with a learning disability who uses institutional language within the hospital culture is not necessarily demonstrating their true understanding or experience of seclusion. Language has the potential to act as a barrier to understanding service user perception.

Implications for Future Research
• The methodological approach taken through the interpretation and use of Case Study methodology allows for the individual experience to guide our knowledge and insight into current practices. This research could inform future approaches to enquiring into the lives of people with a learning disability, encouraging participation and an individualised approach that enables us to better understand their experiences through primary qualitative research.
• This study discovered that seclusion could have a different meaning to those experiencing it from the way in which policy and process has been steered. Seclusion to some was shown at times to be somewhere that women could retreat to and yet to some reinforced an already established power imbalance that they had always accepted and experience on account of their past experiences and at times, their gender. Future research can explore this subject further through involvement of the participant in deconstructing the concepts of restrictive practice and inspire a confidence to involve those in studies whose health may fluctuate over allocated research time.

This research can inform the way in which we faithfully capture the voices of those less heard in research with learning disabilities.

This research contributes to our current knowledge by highlighting gender differences which call in to question processes of seclusion and the way in which these are implemented for both women and people with a learning disability. The research demonstrates that change is required through the way in which women perceive seclusion both as punishment but also as a safe space through which to escape difficult experiences within the ward environment.

Item Type:	Thesis (Doctoral)
Dates:	Date Event 29 August 2022 Submitted 16 May 2023 Accepted
Uncontrolled Keywords:	Learning Disabilities, Intellectual Disabilities, Seclusion, Women, Gender, Secure Hospital
Subjects:	CAH02 - subjects allied to medicine > CAH02-04 - nursing and midwifery > CAH02-04-08 - learning disabilities nursing
Divisions:	Doctoral Research College > Doctoral Theses Collection Faculty of Health, Education and Life Sciences > School of Nursing and Midwifery
Depositing User:	Jaycie Carter
Date Deposited:	08 Jun 2023 15:52
Last Modified:	08 Jun 2023 15:52
URI:	https://www.open-access.bcu.ac.uk/id/eprint/14447

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