Celebrating success, sustaining change
The reduction and elimination of restrictive practices continues to be a priority for New Zealand mental health services. Over the last 20 years, the movement towards recovery and people-centred care in service planning and delivery in New Zealand has supported the implementation of least restrictive practice. (Ministry of Health 2018). In He Ara Oranga: Report of the Government Inquiry into Mental Health and Addiction, a transformative approach to mental health and addiction service delivery, planning and design is called for, modelled within a wellbeing framework (Ministry of Health 2019).
Several people, roles, and teams across the motu have been instrumental in supporting least restrictive practice within adult mental health inpatient services. Their commitment to best practice has been pivotal in reducing seclusion and restrictive practices.
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MidCentral success story
In this video, filmed at Te Whatu Ora - Health New Zealand Te Pae Hauora o Ruahine o Tararua MidCentral, we hear from kaimahi as they share their experiences using the Six Core Strategies© service review tool to reduce and work toward eliminating the use of seclusion in mental health care. These strategies focus on promoting a safer, more supportive environment for tāngata whai ora by reducing restrictive practices and building a culture that is mana enhancing, trauma informed, and person centred. We explore the journey of creating and sustaining change and the importance of eliminating restrictive practices in mental health services across New Zealand.
Mental Health, Addiction and Intellectual Disability Service (MHAIDS) Health New Zealand | Te Whatu Ora, Capital, Coast, Hutt Valley and Wairarapa success story
In this series of six videos, kaimahi from the Mental Health, Addiction and Intellectual Disability Service (MHAIDS) discuss how they have used the Six Core Strategies© service review tool to reduce and work toward eliminating the use of seclusion in mental health care.
Leadership
Kym, James, and Menetta talk about how the Six Core Strategies© leadership strategy has been used to significantly reduce the use of seclusion in inpatient mental health units across Te Whanganui-a-Tara. 12 minutes
Lived Experience
Suzie, Cushla, and Caitlin talk about how the Six Core Strategies© full inclusion of lived experience strategy has been used to significantly reduce the use of seclusion in inpatient mental health units across Te Whanganui-a-Tara. 12 minutes
Use of data to inform practice strategy
Tashana and Rongo talk about how the Six Core Strategies© use of data to inform practice strategy has been used to significantly reduce the use of seclusion in inpatient mental health units across Te Whanganui-a-Tara. 24 minutes
Workforce development
Clarissa, Katie, and Danie talk about how the Six Core Strategies© workforce development strategy has been used to significantly reduce the use of seclusion in inpatient mental health units across Te Whanganui-a-Tara. 7 minutes
Use of seclusion and restraint reduction tools
Clarissa, Cushla, and Katie talk about how the Six Core Strategies© use of seclusion and restraint reduction tools strategy has been used to significantly reduce the use of seclusion in inpatient mental health units across Te Whanganui-a-Tara. 8 minutes
Debriefing techniques
Dennis, Mei, and Nito talk about how the Six Core Strategies© debriefing strategy has been used to significantly reduce the use of seclusion in inpatient mental health units across Te Whanganui-a-Tara. 22 minutes
Health New Zealand | Te Whatu Ora | Nelson Marlborough success story
As part of the Celebrating Success, Sustaining Change series, we’re sharing a powerful audio file series from Wahi Oranga Mental Health Inpatient Unit in Nelson about their journey to eliminate seclusion. Listen to the insightful korero with kaimahi, leaders, and people with lived experience. This series highlights the challenges, innovations, and lasting impact of this mahi. Join us in learning from their experiences and celebrating the progress toward safer, more inclusive care.
In this series of five audio files (ranging from 10 to 25 minutes in length) hosted by Nikita Fleming (Charge Nurse Manager at the Wahi Oranga Mental Health Inpatient Unit), kaimahi talk through how they have used the Six Core Strategies© service review tool to work toward reducing restrictive practices and eliminating the use of seclusion in mental health care in the Nelson Marlborough region.
Leadership to drive organisational change
In this episode, aimed particularly at mental health leadership and policy writers, our guests Janine (Mid Shift Coordinator), Keiley (Clinical Nurse Coordinator), and Liam (Clinical Coordinator), share their experiences using strategy one – Leadership, from the Six Core Strategies© service review tool. They share their insights and experiences around:
Leadership in action: Examples from Wahi Oranga highlight successful initiatives such as discharge packs tailored to localities, daily bed management meetings to coordinate care, and education sessions for clients on topics like anxiety and sleep hygiene.
Innovative initiatives: Programs like the shop run address client needs for essentials, while the DASA tool monitors patient behavior to support wellness journeys. These initiatives enhance client experiences and staff effectiveness.
Collaboration with emergency services: Improved communication and collaboration with police, ambulance, and social services have led to better outcomes for whai ora. Regular meetings and education initiatives strengthen these relationships.
Here are some more resources about leadership:
Arataki | A Let's get real approach to leadership | Te Pou
Leadership development directory | Te Pou
CPSLE | Managers Guide | Lived Experience Workforce | Te Pou
Full inclusion of lived experience
In this episode developed primarily for clinicians, peer support kaimahi and advocacy groups, our guests Jenny (Consumer Advisor) and Marina (COMPASS Community Peer Support and Advocacy Team Leader at the Health Action Trust), discuss their experiences using strategy two – Full Inclusion of Lived Experience, from the Six Core Strategies© service review tool. Tune in as Jenny and Marina explore the power of lived experience in creating more compassionate, person-centred care. You can also watch Jenny’s video sharing her experience of seclusion here.
Implementation in practice: At Wahi Oranga, kaimahi have applied these strategies to create safer and more effective services. Real-life examples highlight the positive impact on individuals and families.
Lived experience perspectives: Including lived experience in governance, planning, and evaluation builds trust and ensures services address the needs of tangata whai ora. Advanced directives empower individuals to articulate their preferences when unwell.
Peer-led initiatives: Compass peer support services, including ED initiatives and community mobile teams, provide compassionate support, reduce repeat ED visits, and enhance outcomes for individuals in crisis.
Service review tool: The tool helps identify areas for improvement and guides progress in reducing seclusion and restraint. Transparent communication and collaboration are essential for success.
Workforce development and training in least restrictive practices
In this conversation for kaimahi across human resources, clinical, education and quality improvement roles, kaimahi Kadin (Nurse Practitioner) and Sarah (Nurse Educator), share their insights on using the Workforce Strategy from the Six Core Strategies© service review tool. Join Kadin and Sarah as they talk about:
Leadership and implementation: Nikita Fleming, the host, highlights the importance of leadership in reducing restrictive practices. Kadin, a registered nurse, shares how the Six care strategies© guide their service, providing a broad framework to identify strengths and areas for improvement. Leadership is vital to driving these changes.
Training and cultural shift: Sarah Alan, a nurse educator, discusses the shift in training focus from restraint techniques to communication, de-escalation, and trauma-informed care. This cultural change reflects a more compassionate and person-centered approach.
Innovative initiatives: Kadin shares the success of introducing vaping products as a de-escalation tool, meeting immediate needs and reducing stress for tāngata whai ora. This initiative demonstrates empathy and a commitment to minimizing distress during inpatient stays.
Learn more about Keeping it real | Kia pono te tika, a framework which describes the values, attitudes, knowledge, and skills required for working alongside tāngata whai ora and whānau experiencing addiction and/or mental health challenges.
Using data to inform decision-making and monitor progress
In this episode, kaimahi Scott (Systems & Analytics Business Partner) and Tamarin (Clinical Nurse Specialist) share how they’ve applied the Use of Data to Inform Practice strategy from the Six Core Strategies© service review tool. Tune in as Scott and Tamarin highlight:
Practical implementation: Kaimahi at Wahi Oranga Nelson Marlborough's inpatient mental health unit shared real-life examples of applying the strategies, highlighting their impact on improving experiences for people and their whānau.
Guest insights: Scott Starling, a systems and analytics business partner, emphasised the role of data in identifying trends, improving systems, and enabling informed decisions. Tamara, a clinical nurse specialist, discussed using data to adjust staffing and reduce seclusion events, as well as the value of electronic medical records.
Collaboration and tools: Both guests highlighted the importance of leadership, cultural assessments, peer-led support, respite care, and tools like electronic dashboards, advance directives, and debriefing techniques in reducing restrictive practices.
Learn more about The New Zealand Mental Health and Addiction Key Performance Indicator (MHAKPI) Programme, designed to support quality and improvement across the sector through collaboration, improvement and learning:
MH&A KPI Programme – KPIs for the NZ Mental Health & Addiction Sector
Debriefing and review processes to support continuous improvement
In this episode, kaimahi Hana (Ngāti Whatua), Cultural Support and Allied Health Assistant, and Jenny, Consumer Advisor, discuss how they’ve used the Debriefing Strategy from the Six Core Strategies© service review tool. Tune in as Hana and Jenny explain:
Leadership and inclusion: Emphasises leadership to drive change and full inclusion of lived experience, involving tangata whai ora and whānau in service design and evaluation.
Data-driven decision-making: Using data to monitor progress and inform decisions for continuous improvement.
Workforce development: Training staff in less restrictive, trauma-informed, and mana-enhancing practices.
Debriefing processes: Supports both individuals and staff, fostering reflection, learning, and well-being while informing service improvements.
Facility improvements and personalised care: Insights from debriefing sessions lead to environmental upgrades and the introduction of advanced directives for better care experiences.
Cultural shift towards empowerment: Prioritising healing, choice, and empowerment to create safe, responsive, and effective mental health services.
More resources on trauma:
Evidence update for least restrictive practice in Aotearoa | Te Pou
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