Mental health care under scrutiny
Nurses must drive changes to reduce seclusion while ensuring safety.
The NSWNMA wants nurses to contribute to a state government review of the use of seclusion, restraint and observations in mental health facilities.
The review is being carried out by a six-person panel including the NSW Chief Psychiatrist Dr Murray Wright.
Health Minister Brad Hazzard said the review would consider whether existing legislation, policy, clinical governance and practice standards are “consistent with national standards, international best practice and the expectations of patients and the community”.
“We need to know appropriate policies are in place in our hospitals and mental health facilities and the extent to which staff actually adhere to existing policies and protocol,” he said.
NSWNMA General Secretary Brett Holmes said the union welcomed the inquiry and acknowledged the work being done by many agencies to reduce the use of seclusion nationally.
“The NSWNMA holds the view that the use of seclusion and restraint can be reduced in NSW, but only with the right support and resources in place,” he said.
“Safety of nurses and patients has always been our priority, along with evidence-based clinical practice that provides best care for mental health clients.
“Too many nurses incur injury during restraint and seclusion procedures.”
Inquiry will visit hospitals
Members of the inquiry panel will visit hospitals, acute mental health units, mental health intensive care units, and declared emergency departments and review past cases of seclusion and restraint.
The public will be able to make submissions and “there will be the opportunity for face-to-face consultations through public workshops” according to minister Hazzard.
The union has circulated a list of questions to members to help them prepare their comments and responses to the inquiry panel as they visit mental health facilities across NSW.
The list includes questions on staffing, skill mix and training.
“Mental health nurses need to drive the changes required to help reduce seclusion and restraint across NSW and ensure the safety of mental health clients through evidence-based best practice,” Brett said.
“This will require campaigning for the resources needed to achieve this.”
He said the review would also examine observations in mental health units.
“It is a timely reminder that failures in following local policy and requirements for patient observations have very serious consequences for patients and disciplinary issues for our members.”
New grads exposed to danger
“ We don’t seclude people unless we absolutely have to,” says Jack Schwartz, a mental health nurse of 40 years’ experience.
Jack works at the in-patient psychiatric unit of Coffs Harbour Health Campus.
He is president and delegate of the union’s Coffs Harbour mental health branch and a member of the NSWNMA mental health reference group.
Jack says patients are usually secluded because they cannot control themselves, are a danger to themselves and, or others and have assaulted someone.
“Some patients are so out of control they need to be restrained and placed in seclusion by a large team of police and HSAs (health services assistants).
“The need to restrain such patients is greater at night when we have only four nurses and one HSA on duty.”
Jack says his unit’s seclusion room is too small, the ceilings are too low and the only access to a toilet is through a locked door and across a hallway.
A shortage of trained and experienced nurses
The unit suffers from a shortage of trained and experienced mental health nurses and staff frequently do double shifts or extra shifts.
“We have a lot of great junior nurses but they have little or no training in mental health. They are lucky if they get 2–3 weeks’ university training.
“These semi-trained staff are being put in dangerous situations they’re not trained to handle.
“We are so busy here with our own patients that we often do not get enough time to help the new grads with theirs.
“This is contributing to a high turnover of new grads. It’s not their fault and it’s not the fault of those of us who are trying to look after them. It’s a system problem.
“Many of us who have the ability to train and do counselling are nearing retirement age and leaving the service, so who is going to train the new nurses?”
Have your say
The NSW Government has established an inquiry into the use of seclusion, restraint and observation of patients with mental illness in NSW mental health facilities.
The NSWNMA encourages members to actively participate in this review.
For more information on the inquiry visit: http://www.health.nsw.gov.au/patients/mentalhealth/Pages/default.aspx