Recent media coverage has highlighted the ongoing and justified public concern for service users with very high and complex mental health needs. Te Pou supports the work of the Ministry of Health and district health boards (DHBs) to understand and problem solve the many and complex variables that are impacting on both the basic human rights and health of these people, their families and the staff members working with them.
It can be a struggle for DHBs to manage demand and capacity. Having a mixture of people with very different mental health issues in mental health units is complex to manage. There are not facilities that enable individualised care and this can lead to some people responding to the environment very differently. Some people enter services under challenging circumstances or the influence of drugs or alcohol which can affect their ability to respond positively to boundaries on their behaviour. Staff need to be very well equipped to deal with this level of distress, anxiety or agitation.
Te Pou is working with DHBs around New Zealand to reduce the use of seclusion and restraint. As a mental health workforce development centre, Te Pou shapes practice by providing DHBs and their staff with information, training and support that is informed by current best practice, innovation and evidence.
Examples of support we provide includes:
- working with DHB leadership teams to support least restrictive practice
- working with clinical teams to examine their values and experiences and how this informs practice
- training for DHB staff in sensory modulation and trauma informed care
- regular information and research updates and the sharing of practice innovation between DHBs
- advising DHBs on follow up and preventative activities such as debriefing and care planning
- analysing data for DHBs to inform their decision making.
Te Pou has been supporting and leading seclusion and restraint reduction since late 2008. In addition to providing best practice updates and information to all DHBs, the team are more actively working to support clinical teams in 10 DHBs.
The use of seclusion and restraint has declined
The national information system (PRIMHD) tells us the use of seclusion and restraint has declined over the last few years. The total number of people who experienced seclusion while receiving mental health treatment in an inpatient service had decreased by 32 per cent since 2009. The total number of hours spent in seclusion had decreased by 55 per cent since 2009.
The gains that have been made are significant. In our work we interact with many teams and organisations that are positively focused on providing safe and high quality mental health services, without the use of seclusion or restraint. Some DHBs are currently discussing the complete elimination of seclusion from their services.
Innovative practices are being shared internationally
In its work with DHBs, Te Pou draws on international research and practice innovation as a member of the International Initiative of Mental Health Leadership (IIMHL). We connect to the UK, USA, Canada, Scotland, Ireland, Australia and Sweden to share innovative practice and compare the use of restrictive practice and reduction goals.
The main international evidence based model promoted in DHBs by Te Pou is the Six Core Strategies for reducing seclusion and restraint. Te Pou developed the checklist resource for New Zealand mental health services based on the original model from the National Association of State Mental Health Programme Directors (NASMHPD) in Pennsylvania, USA. This internationally recognised model provides a range of proven strategies and practice-based approaches that assist mental health service staff and service users to prevent and reduce seclusion and restraint.
Progress is being made
Many services have made great progress towards reducing seclusion and restraint. Two different DHBs recently reported to Te Pou they are often cancelling seclusion and restraint review meetings, because no seclusion or restraint events have occurred.
Increasingly DHBs are using international best practice co-design and co-leadership models that actively involve the perspective of service users. This approach is known to strongly influence seclusion and restraint reduction and prevention.
Te Pou believes New Zealanders deserve the best mental health, addiction and disability services, provided by a skilled workforce. We continue to support the workforce to innovate, develop and provide least restrictive practices in contemporary mental health services.