Least restrictive practice
What is least restrictive practice?
Least restrictive practice is a term used to describe a wide range of approaches, practices and activities that supports a person’s autonomy and makes them the centre of all choices. Combined with a human rights and trauma informed focus this supports the goal of eliminating the use of restrictive practices and ensuring best outcomes for people accessing services.
This guidance is underpinned by the belief that the use of restrictive practices is an adverse event in mental health settings and potentially traumatising to people. National consistency and compassionate and empowering responses to people is key to a continued positive practice direction.
Te Pou works closely alongside Te Whatu Ora health districts, providing advice and consultation to support change and ongoing practice development in working towards the elimination of the use of seclusion and restraint. The use of data is a key focus of this work. Te Pou collate and analyse the seclusion data collected nationally, and work with Te Whatu Ora health districts to encourage active use of this data to inform and improve practice change.
Eliminating the use of seclusion and restraint
Seclusion and restraint are traumatising experiences for people receiving services and staff working in services. Working to eliminate seclusion and restraint is highlighted as a priority action in He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction (2018).
Te Pou have developed a range of evidence-based tools to support inpatient services to eliminate the use of seclusion and restraint
New Zealand has made good progress towards eliminating the use of seclusion and restraint and Te Pou will continue to support Te Whatu Ora health districts in this work.
Collaboration with Te Tāhū Hauora Health Quality & Safety Commission
Te Pou supports the aim of the Health Quality & Safety Commission’s Zero seclusion: Safety and dignity for all | Aukatia te noho punanga: Noho haumanu, tū rangatira mō te tokomaha project of contributing to the goal of zero seclusion by reducing seclusion rates in adult mental health inpatient units (excluding forensics) in participating localities to 5 percent or below by December 2023.
The Commission’s pono (to be true, honest, valid, sincere) consumer story videos highlight seclusion experiences in Aotearoa New Zealand.
Te Pou is privileged to share videos from Te Kete Pounamu member, Haki Davis, and Te Whatu Ora – Nelson Marlborough consumer advisor, Jenny Fenwick, in which they describe how seclusion affected them and their whānau and suggest alternative actions they believe staff could have taken.
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Haki Davis: youtube.com/watch?v=89VedDizp34&t=16s
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Jenny Fenwick: youtube.com/watch?v=evjxyocCgfI
The Six Core Strategies©
The Six Core Strategies are evidence-informed approaches effective in reducing seclusion and restraint events. The refreshed Six Core Strategies© service review tool (2020) was published following sector feedback and commitment to seclusion reduction and eventual elimination.
Working with Māori
Māori who access mental health and addiction services experience significantly higher rates of seclusion than non-Māori. Te Pou has an equity focus that informs our least restrictive practice work. We work with Manatū Hauora Ministry of Health, Te Aka Whai Ora, and Te Whatu Ora Health New Zealand to address inequities experienced by Māori.
The evidence update for least restrictive practice in Aotearoa New Zealand November 2022 by Te Pou is available to download.
Sensory modulation
Whakaāio ā-rongo or sensory modulation is a tool that supports trauma informed approaches and elimination of restrictive practices. It is an evidence-based tool sitting within the Six Core Strategies© and has proven to have a positive impact on people. Sensory modulation is becoming well embedded in Aotearoa New Zealand mental health and addiction services.
Mental Health Act Guidelines
He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction (2018) recognised urgent need for change in the way the Mental Health (Compulsory Assessment and Treatment) Act 1992 (the Act) is used in practice. In September 2020, Manatū Hauora Ministry of Health published Guidelines for reducing and eliminating seclusion and restraint under the Mental Health (Compulsory Assessment and Treatment) Act 1992. These aim to clarify the responsibilities of mental health services and clinicians. They offer guidance on how sections of the Act can be applied to promote and protect people’s rights. They promote a “humanising” culture in practice to reduce harm to people and whānau.
Te Pou has developed a suite of resources to support the practice outlined in the Guidelines. These include e-learning modules for the workforce and up-to-date information for people and whānau when being placed under the Act.
Safe Practice Effective Communication | SPEC
Safe Practice Effective Communication (SPEC) is a four-day, Te Whatu Ora localities based national training course which supports least restrictive practice in mental health inpatient units.
Evidence updates
Te Pou continues to support services to reduce the use of restrictive practices through growing evidence by way of producing research articles and resources. Evidence updates provide information and a selection of tools and resources to support this.
Read the evidence updates on least restrictive practice from Te Pou.
Least restrictive practice evidence update March 2024 - Aggression
Least restrictive practice evidence update December 2022
Least restrictive practice evidence update November 2022
Least restrictive practice evidence update October 2021
Least restrictive practice evidence update May 2021
Key Contacts
Resources
Te Pou has a wide range of evidence-based resources and tools to help the mental health, addiction and disability workforces.
Learn MoreOur work
Te Pou works alongside mental health and addiction services, and disability organisations to understand their priorities and workforce challenges.
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