Eliminating Seclusion Use for Women in Secure Forensic Hospitals. Are We Doing Enough to Consider Sex and Gender Differences for Elimination?

The reduction and eventual elimination of seclusion is a global priority. In 2021, The Royal Commission into Victoria's Mental Health System recommended that seclusion use be eliminated from mental health services within 10 years. This is long needed given human rights concerns and known harms associated with seclusion use. Yet the Commission failed to adequately consider gender-specific needs of women, and women who may be at increased risk of harms associated with seclusion use. Further, current approaches for seclusion reduction lack an explicit gendered lens. There are noted gendered differences in women and men which can influence how mental ill health and trauma are experienced and expressed. Past experiences of trauma have a large negative impact. For women in secure forensic hospitals, the negative effects of seclusion may be more detrimental in exacerbating harm and trauma. While rates of seclusion are generally declining across general and forensic mental health services, seclusion remains higher in forensic hospitals, and there is a lack of transparency around the rates of seclusion for women. In this paper, the author explores differences between women and men in the context of mental ill health, current approaches for seclusion reduction and whether these adequately consider sex and gender differences. With Victoria approaching the halfway point to the elimination target, the author recommends transparency in reporting of seclusion rates separately for women, and greater focus is paid to the recognition of gender differences in approaches for seclusion reduction and eventual elimination.