The region’s mental health facilities will work to eliminate the use of seclusion and restraint after a damning report into the restrictive practices across the state.
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Report author NSW chief pyschiatrist Dr Murray Wright toured facilities at Wollongong and Shellharbour public hospitals, and spoke with patients and staff, in August as part of the independent review which released its findings on Monday.
The NSW Government has committed to implementing its 19 recommendations, which include establishing minimum training standards for staff, improving observation and a policy to work towards the elimination of seclusion and restraint.
Illawarra Shoalhaven Local Health District executive director mental health Caroline Langston said the district would work with government on the reforms.
‘’(The health district) participated in the review and will work with our consumers, staff and the Ministry of Health to help implement the recommendations as they relate to our local mental health services,’’ she said.
NSW Health Minister Brad Hazzard announced the review in May after horrific footage emerged of a patient’s final days at Lismore Base Hospital in 2014. Miriam Merten died from traumatic and hypoxic brain injury caused by numerous falls after she was locked, naked and chemically restrained, in a seclusion room in the mental health unit.
Observation practices at Shellharbour Hospital’s mental health facilities have also come under scrutiny in recent years. In July 2014 a patient was killed by another patient at the Eloura West unit; while the NSW Coroner’s Court is reviewing the unexplained death of Nikola Nastovski at the Mirrabrook unit on May 4 this year.
However Dr Wright told the Mercury on Monday that the review team had not sought to investigate any particular service, or complaint.
‘’What was striking though, was how similar things were wherever we went,’’ he said.
‘’We got the same themes from consumers and community representatives at every single consultation.
‘’They all raised the issue of humanity and compassion and the issue that restrictive practices are traumatising. We got the same message from staff – nobody likes it.’’
In NSW, there were nearly 3700 episodes of seclusion in 2016-17. In this same period, 2200 people were secluded and on average they spent five and a half hours in seclusion.
According to the report many consumers, carers and their families described encounters with health services as ‘’lacking compassion’’ and ‘’humanity’’.
Many reported feeling ‘’dehumanised’’ and stripped of their dignity, while some reported that seclusion and restraint were used as a threat or punishment, or as a means of ‘’enforcing compliance and obedience’’.
The report stated that ‘’culture and leadership’’ was also an issue – with stigma and discrimination towards mental health consumers apparent in many cases.
And while there had been a history of efforts at seclusion and restraint reduction in Australia, there were some ‘’clear failures’’ and a loss of momentum for improvement.
‘’The term we are adopting and believe most appropriate is that we must continue to work towards elimination of these restrictive practices,’’ Dr Wright said.
‘’We can’t say that under no circumstances should these be used, or we could inadvertently create risk for a patient, or staff member. The question is whether we can do it better.’’
Dr Wright said he was very encouraged by the government’s initial reaction to the report and its recommendations.
Mr Hazzard and Mental Health Minister Tanya Davies confirmed all recommendations had been accepted, to prevent the inappropriate use of seclusion and restraint in acute mental health units and emergency departments.
‘’Whilst the government will need to work with our local health districts to bring about change in practices and procedures, the message from the review is loud and clear - seclusion and restraint of mental health patients should be a last resort,’’ Mr Hazzard said.
He said the government would immediately invest $20 million, to enable hospital managers to work with their staff to improve the therapeutic environment inside acute mental health units.
Mrs Davies said a review of the use of safe assessment rooms in emergency departments would also start.
‘’This has been a difficult process for many consumers, their families, mental health workers and the review team and we would like to sincerely thank you for your honesty and courage during this process,’’ she said.
The NSW Ministry of Health will now develop a plan for implementation of the recommendations, which will be delivered to the ministers by March 2018.
The full report can be viewed online at www.health.nsw.gov.au.