Speaker: John Allen (NSW Health)
“Aim to reduce and where possible eliminate use of secluson and restraint in public mental health services”.
Attitudes have not however changed that rapidly even with the work we have done over the past three years. He discusses the key principles for seclusion and restraint practice (7 principles). One of the most bureautised procedures relates to seclusion and restraint.
He then discusses the definition of Seclusion:
- the consumer is alone
- applies at any time of the day or night
- duration is not relevant in determining what is seclusion
- the consumer cannot leave of their own accord
He know discusses NSW data (2008) regarding seclusion. Shows 7% of people admitted to hospital will have an episode of seclusion. There is a trendline that is going down, we have done something. This however is a 10-15 yr project.
Shows graph of average hrs spent in seclusion – believes that there are wins there.
Now shows ACT seclusions data trending downwards to 4%.
What is the evidence for seclusion use? discusses Cochrane – no controlled studies exist that evaluate it.
What do more systematic studies tell us? widespread variation in use across hospitals and across time
Discusses Perception of seclusion and seclusion rooms by MH nurses (2010) – strongly endorsed negative effects of seclusion on patients feelings during seclusion, 87% disagreed that seclusion should not be used,
What are our successes? Consumer and Carer Involvement, Practice Development and Change
Will targets help? we suggest 15% average drop
Restraint Definition discussed
Restraint is more common than seclusion, mgt systems dont often report restraints.
He then goes through a list of all the things we need to do in future
Tough Issues: the balance of medication, restraint and environment, team training, design guidelines vs money, sensible and infromed approach to smoking reduction and cessation.
Questions not recorded
seclusion in my world is better than physical restraint ie
4 plus people holding you or manicled the sides of a bed
Anyhow once given sedation either oral medication or IMI injection
and have settled and no longer a harm to self or others the seclusion is ceased and the patient is no longer
in isolation
Seclusion rooms in all my years hasnt been used as punishment or to manage behavior only physical agression or if a patient is exhibiting sexualy explicit behavior