What makes it hard to change?

Ethical Tensions

Healthcare providers often experience internal conflict between their ethical and moral values and professional responsibilities. At times, providing safe, quality, and coercion-free care can be in direct conflict with their professional duty to maintain safety and address violence on the unit. (Hawsawi et al., 2020)
- “We don't really know what to do, because you can't really justify leaving a patient without knowing what they have on them, or without removing things that could be harmful to them or other people. But at the same time, how far do you go in removing those things? So that's where some of that ethical dilemma is.”

Institutional policies that normalize seclusion can pressure health care providers to act in ways that are misaligned with their moral and ethical values (Mooney & Kanyeredzi, 2021; Slemon et al., 2017)
- “I was unsure if this [use of seclusion] was a sort of archaic practice that you know continues and everybody [health care team] views as unethical”

Lack of alternatives to seclusion and impetus on risk-management culture (Hawsawi et al., 2020; Slemon et al., 2017)
- “But it's always the last resort. You know, we try all of the other things. We don't put people in seclusion, if we don't have to. It's not something that we want to do.”

Structural Barriers

Staffing-related barriers, including staffing levels (fewer nurses per shift and fewer total hours worked) and skill mix (the proportion of staff with more experience and higher qualifications), are known factors that influence rates of seclusion (Woodnutt et al., 2025).
- “They [Health care providers] also have very limited amount of time and resources to spend on everybody, and so sometimes it's they're doing the bare minimum”

The physical design of the unit – particularly the absence of sensory tools and dedicated de-escalation spaces – can limit the alternatives available to seclusion (Snipe & Searby, 2023).

When healthcare providers lack training in trauma-informed approaches and de-escalation strategies, their capacity to draw on alternatives to seclusion is limited (Snipe & Searby, 2023).

Legal and Oversight Gaps

In Canada, there is no consistent legal framework regulating seclusion use, resulting in gaps in oversight of seclusion use, such as circumstances leading to seclusion, its duration, and frequency (Perryman, 2024).

A regulatory patchwork of laws and policies within health systems and geographical jurisdictions is challenging to scrutinize broadly and equitably (Chaimowitz et al., 2026). For example, BC’s Mental Health Act does not have any limits on the use of seclusion or safeguards pertaining to duration or frequency of its use (Health Justice, 2025).

Ethical Tensions

Healthcare providers often experience internal conflict between their ethical and moral values and professional responsibilities. At times, providing safe, quality, and coercion-free care can be in direct conflict with their professional duty to maintain safety and address violence on the unit (Hawsawi et al., 2020).
- “We don't really know what to do, because you can't really justify leaving a patient without knowing what they have on them, or without removing things that could be harmful to them or other people. But at the same time, how far do you go in removing those things? So that's where some of that ethical dilemma is.”

Institutional policies that normalize seclusion can pressure health care providers to act in ways that are misaligned with their moral and ethical values (Mooney & Kanyeredzi, 2021; Slemon et al., 2017).
- “I was unsure if this [use of seclusion] was a sort of archaic practice that you know continues and everybody [health care team] views as unethical”

Lack of alternatives to seclusion and impetus on risk-management culture (Hawsawi et al., 2020; Slemon et al., 2017).
- “But it's always the last resort. You know, we try all of the other things. We don't put people in seclusion if we don't have to. It's not something that we want to do.”

Staffing-related barriers, including staffing levels (fewer nurses per shift and fewer total hours worked) and skill mix (the proportion of staff with more experience and higher qualifications), are known factors that influence rates of seclusion (Woodnutt et al., 2025).
- “They [Health care providers] also have a very limited amount of time and resources to spend on everybody, and so sometimes it's they're doing the bare minimum”

The physical design of the unit – particularly the absence of sensory tools and dedicated de-escalation spaces – can limit the alternatives available to seclusion (Snipe & Searby, 2023).

When healthcare providers lack training in trauma-informed approaches and de-escalation strategies, their capacity to draw on alternatives to seclusion is limited (Snipe & Searby, 2023).

In Canada, there is no consistent legal framework regulating seclusion use, resulting in gaps in oversight of seclusion use, such as circumstances leading to seclusion, its duration, and frequency (Perryman, 2024).

A regulatory patchwork of laws and policies within health systems and geographical jurisdictions is challenging to scrutinize broadly and equitably (Chaimowitz et al., 2026). For example, BC’s Mental Health Act does not have any limits on the use of seclusion or safeguards pertaining to duration or frequency of its use (Health Justice, 2025).