Review of seclusion, restraint and observation of consumers with a mental illness in NSW Health facilities

Mental health Medicine New South Wales

The review was announced following the release of distressing closed circuit television (CCTV) footage of Ms Miriam Merten in seclusion showing events which contributed to her death.

Public and professional outrage spurred this review of current practice to make recommendations to reduce, and where possible eliminate, the use of seclusion and restraint in NSW. In aiming to prevent harm and promote safer services for consumers and staff, the review team has also considered the broader strategies for clinical governance, safety and quality within the services reviewed.

The use of seclusion and restraint in modern health settings is a key focus, given the well documented traumatic and damaging impact of these practices. 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. These figures do not include seclusions that occurred in NSW public hospital emergency departments.

A primary question is whether our system has the right vision and goals, properly supported by effective strategies, policies and resources, to enable the prevention of seclusion and restraint.

This review is based on extensive and detailed consultation. It has, at times, been a difficult and demanding process, given the stories shared by consumers and carers about their distressing experiences. Having asked so many people to visit and revisit their own private pain, it is imperative that we not only treat all stories with respect, but ensure this information underpins sustainable changes to improve our system of care.

We thank everyone who made the effort to contribute to this review and for their courage in speaking up.

This report describes the strengths and weaknesses of services and outlines some pervasive themes clearly affecting efforts to prevent or reduce seclusion and restraint. It also provides recommendations to help in planning and developing safe, contemporary and compassionate services with the capacity to evolve and improve. This is an opportunity for services to review their models of care, and to realign them to strengthen the efforts to prevent seclusion and restraint.

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