Busting open mental health restraints
Attending a hospital can be anxiety-inducing for anyone. If the reason you’re there is to seek help for a mental health condition, it can be doubly so.
If you, or a loved one, were seeking help in one of NSW’s acute mental health units recently, and you happened to read The Sydney Morning Herald, that fear may well have turned to terror when you read of patients being held in seclusion in some places for almost 25 hours, on average.
Along with others working in the mental health sector, we know that being secluded or physically restrained has no therapeutic benefit and that it can be an extremely traumatic experience for people with a mental health issue.
That’s why there has been so much concern from across the sector about new data from the Bureau of Health Information showing an increase in the duration of patient seclusion. It is an unacceptable practice that should only be used as a last resort.
But what wasn’t reported is that along with this increase in average duration, the average incidence of seclusion in NSW hospitals has fallen from 859 in July to September 2017 to 625 in the same period in 2022, down 27.2% (234) over five years.
This does not diminish the experience of those subjected to restraint and seclusion, but it does show that the use of such restrictive measures is less prevalent, and therefore moving in the right direction.
But perhaps most importantly, it is a tangible example of a step-change in the way mental health is managed in NSW. A decade ago, most of the community would simply never have known this was happening, and definitely not how often and for how long.
Part of our role at the NSW Mental Health Commission is to shine a light on mental health in NSW, to monitor what is happening so improvements can be made. And data like this makes it possible to have open discussions about on-the-ground realities and to identify solutions.
Data also points to where we need to dig deeper to understand what’s happening to the people behind these numbers. We may need to do more to support the capacity of the workforce to respond with evidence-based interventions and empathy in these high-stress situations, working within a multidisciplinary team including mental health peer workers. This is part of the Commission’s Living Well in Focus strategy for 2020-2024.
But it may also be that regardless of the resources or skills available, a particular inpatient may have treatment resistant mental illness so ends up in highly stressful and sometimes unsafe situations with staff or other patients. Perhaps a new pharmaceutical regimen may take time to take effect, so seclusion or restraint unfortunately becomes the best way to keep everyone safe until their symptoms decrease. In those cases, it may not be about resources or skills, but focusing on options for people with have highly complex and at times unsafe behaviours.
The good news is we are no longer totally in the dark about mental health treatment in NSW. And the more we know, the more light is cast and the better we can focus upon improving experiences of care and outcomes.
Catherine Lourey is the NSW Mental Health Commissioner