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Zero seclusion in action

The work of the Health Quality & Safety Commission and Te Pou

The Health Quality & Safety Commission (the Commission) has for several years worked in collaboration with Te Pou, a national centre for workforce development for the addiction, disability and mental health sector in New Zealand, as part of its mental health and addiction quality improvement programme. Below is a description of how both organisations are involved in the Zero seclusion project.

Our roles in zero seclusion

The Commission

The Zero seclusion: Safety and dignity for all | Aukatia te noho punanga: Noho haumanu, tū rangatira mō te tokomaha project specifically focuses on eliminating seclusion in Aotearoa New Zealand. The project is part of the wider MHA quality improvement programme, funded by localities.

The Zero seclusion project has been underway since early 2019. Our goal is to continue sector work with localities to eliminate seclusion in MHA services.

Te Pou

Te Pou works alongside mental health and addiction services to understand their priorities and workforce challenges in reducing the use of restrictive practices. We then use our range of projects and expertise to meet these needs providing tools, training, and resources to improve outcomes and information use.

The tools Te Pou and the Commission use

The Commission

  • The Zero seclusion change package | mōkī aroha uses a set of globally recognised, evidence-based interventions aimed at improving the care of tāngata whaiora while moving towards achieving zero seclusion in mental health inpatient units. When implemented, zero seclusion project teams will provide wider access and choice to effective holistic Māori cultural and Western clinical interventions, which in turn will reduce seclusion rates and improve health equity. The package is both a coaching tool and resource for zero seclusion project teams as they plan, design, test and apply evidence-informed practices in their local environments. Used effectively, the package should help teams achieve breakthrough improvements which are able to be applied across the entire mental health sector.
  • In collaboration with the Key Performance Indicator programme, Te Pou and the Commission are providing teams with access to the Commission’s Zero seclusion measures dashboard. This report shows the Zero Seclusion Outcome Measures, developed by the Health Quality and Safety Commission (HQSC) from 2020. The dashboard compares seclusion events and tāngata whai ora numbers to total inpatient numbers.

Te Pou

  • The refreshed Six Core Strategies© service review tool (2020) was published following sector feedback and commitment to seclusion reduction and eventual elimination. This service review tool aims to support leaders and managers in implementing the Six Core Strategies© in mental health services. The tool is designed to help services to regularly review their progress in shifting towards least restrictive practice through identifying key priorities and supporting ongoing quality improvement and systems change. The Six Core Strategies© service review tool can be accessed here.
  • There is close alignment in this work with Let’s get real, the knowledge and skills framework for working with people with mental health and addiction needs. Applying the values and attitudes of Let’s get real develops a values-based platform for least restrictive practices along with the essential engagement skills described in the Real Skill: Working with people with mental health and addiction needs. A range of resources are available to promote capability in these areas.
  • Whakaāio ā-rongo or sensory modulation is a tool that supports trauma informed approaches and contributes to the reduction of restrictive practices. It is an evidence-based tool sitting within the Six Core Strategies© and has a positive impact on many people who access services. Sensory modulation is becoming well embedded in New Zealand mental health and addiction services. Sensory modulation contributes to reducing and eliminating restrictive practices through supporting people to self soothe and regulate their responses. Te Pou continues to work in partnership with districts in embedding sensory modulation. Our current focus is to establish practice sustainability by supporting learning and development activities across a wide range of service settings. The national practice group supports this mahi and includes representation from lived experience, whānau and Māori advisor roles, as well as occupational therapists and nurses.

The training Te Pou and the Commision provide

The Commission

  • The Zero Seclusion project team offers quality improvement coaching to localities. These sessions are available for all localities and support teams to improve their understanding of data, improvement methodology, implementation of the change package.
  • The programme has also worked on the understanding bias in health care module to support teams to understand what implicit bias is, and how to identify and address it; Te Tiriti o Waitangi, colonisation, and racism; and looks at consumers and clinicians’ real-life experiences of bias, both implicit and explicit.

Te Pou

  • Safe Practice Effective Communication (SPEC) is a district based national training course which supports best and least restrictive practice in mental health inpatient units. This four-day course includes training in restraint minimisation, communication, de-escalation, collaborative ways of working, and the teaching of personal restraint and breakaway techniques. There is a National SPEC Collaborative Governance Board that meets regularly to oversee the implementation and development of SPEC across New Zealand. SPEC Hub is an online platform designed to create a Safe Practice and Communication Hub to support key administrative functions, key communications and professional development across the national SPEC programme.

Shift in seclusion practices for Māori communities

This report is the result of collaboration between Te Pou and Te Tāhū Hauora Health Quality and Safety Commission. It examines the impact of taking a cultural-clinical approach to reducing eliminating seclusion for Māori. This information is for the mental health and addiction workforce, particularly those actively involved in eliminating the use of seclusion.

Training and resources for the Mental Health Act

The recent publication of the revised Guidelines to the Mental Health (Compulsory Assessment and Treatment) Act 1992 provides a timely opportunity to identify workforce development initiatives that will support good practice in the use of the Act and promote awareness and understanding about people’s rights. (See Ministry of Health. 2020. Guidelines to the Mental Health (Compulsory Assessment and Treatment) Act 1992. Wellington: Ministry of Health.)

Te Pou has developed a series of e-learning modules for the workforce alongside additional resourcese for people interfacing with the Act and their whānau.

Zero seclusion updates to the sector

The Commission

The MHA quality improvement programme provides updates via the dashboard, resources to reduce and eliminate seclusion such as our PONO videos and Change Package, quarterly news updates through our e-digest.

Te Pou

Least restrictive practice evidence updates present findings from systematic reviews and some of the research studies in concise, accessible formats. These updates capture the highlights and context for these new findings and are created and disseminated in collaboration with various stakeholders.



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