Despite the fact that I recently earned a time-out threat system again, after a year without one, there are still nurses telling me that I do better meltdown-wise than I used to do. These are nurses here at reso, who cannot compare me to how I functioned at my former ward, because they didn’t know me back there. So they must be referring to how I functioned when I first came here half a year ago. However, I didn’t have a time-out policy then, so apparently I wasn’t as much a danger to myself, the other patients or the staff that I would need one, right? And now I am allegedly better, but I am apparently so dangerous that I need a time-out policy.
Of course, staff could be talking about absolute progress, as in: “Hey, you’ve learned a lot in these six months. You aren’t there yet, but you’ve learned a lot.” This would make sense if a consequence, like a time-out system, existed for not making enough progress: absolutely, I could’ve made progress, while having regressed relatively to expectations, therefore still being eligible for punishment. But that is not what time-out is for: it is to avert or prevent danger. And if a particular behavior is dangerous if it comes from a person who has been here for six months, it must also be dangerous if it comes from someone new – and it may even be possibly more threatening psychologically if the behavior comes from the newcomer, because the other people will not yet know whether the person’s screaming and door-slamming might possibly end in physical assault. It isn’t like, if you get attacked or insulted, you must have more tolerance for it because the patient just arrived, is it?
And even if you are inclined to give a newcomer a second chance, because that patient might not be used to the ward yet, I am assuming you are not talking about tolerance for behavior that is actually dangerous. I wouldn’t hope that any staff member would tolerate it if a new patient assaulted someone else. Assault is dangerous no matter what. And if you decide that door-slamming is dangerous, because it is a threat to the other patients’ psychological wellbeing or something (I never understood the rationale behind it, anyway), it is equally dangerous no matter who does it or in what stage of treatment they are. And just so everyone is familiar with what the Mental Health Act says: seclusion, restraint, forced drugging etc. are only allowed as a way to prevent or avert danger from the patient to himself or other people, and can explicitly and emphatically not be used as punishment. You may think that you can set higher behavior standards for someone who’s been in treatment for six months, but this is not the place in treatment plans where seclusion fits in.