Bermuda's only mental health facility has just one seclusion room for dangerous or suicidal patients, an inquest heard yesterday.

This means staff at the Mid-Atlantic Wellness Institute (MWI) must choose which patient gets use of the room if two or more cases present themselves at the same time.

Psychiatric nurse Michael O'Neil told the inquest into Shandal Richardson's death that another patient had needed the seclusion room on the evening Mr. Richardson hung himself.

Mr. Richardson, 35, was admitted to MWI on March 4 last year after trying to stab himself with a knife at his Southampton home.

He was deemed to be a suicide risk by an Emergency Room doctor at King Edward VII Memorial Hospital before being admitted to MWI where he was placed in the acute care Somers' Annex.

The inquest has previously heard that Mr. Richardson was initially placed in a room at MWI used for "observation and seclusion", which only had a bare mattress and a urinal bucket. However, he was moved to a different room before his death in the early hours of the next day, March 5, when he tied one end of a bedsheet around his neck and the other to a bedpost.

Mr. O'Neil, who was on duty from three p.m. until 11 p.m. on March 4, said Mr. Richardson had been let out of the seclusion room by the time he started his shift, but had not yet been assigned to another room to sleep.

He added that the day in question was particularly stressful as another patient became violent around 7 p.m. and attacked a member of staff.

It took five male MWI employees to subdue and restrain him and inject him with a cocktail of medicine used when patients become aggressive. The patient in question was then moved into the seclusion room for his safety, as well as the safety of others.

While orderlies were busy dealing with the aggressive patient Mr. Richardson and the others had been placed in their rooms, with Mr. Richardson being put in room four.

Once the aggressive patient was dealt with, Mr. O'Neil and other staff discussed where Mr. Richardson should be placed for the evening. The only single room left on the unit had a private bathroom and Mr. O'Neil said they were concerned with putting Mr. Richardson in there in case another person needed to be admitted during the course of the night. Instead, they chose to keep him in room four, which he shared with another patient.

Mr. O'Neil said the staff had no option but to put the other patient in the seclusion room: "The situation that occurred that night did not make decisions easy, we have limited facilities."

But, he added, this did not necessarily mean Mr. Richardson would have been returned to the seclusion room on the night of his death.

"The thing about seclusion is it is not something you just put someone into. You are cutting off their ability for self-determination and cutting them off from all stimulation; light, food, water, visitors and phone calls. So that is not something we just do, it has got to be justified. It is meant for the least amount of time possible."

The inquest continues today.