Mental health starved of funds
The NSW mental health system can reduce the use of seclusion and restraint only if it gets adequate support and resources.
Underfunding of mental health services over many years has hindered the adoption of measures to ensure optimum safety of patients and staff, says the NSWNMA.
A “tight fiscal strategy is now having an impact on clinical outcomes in mental health services,” says a union submission to the inquiry into the practice of seclusion, restraint and observations (see box).
It says increased use of seclusion and restraint cannot be seen in isolation from underlying problems within the NSW mental health service.
“A lack of leadership by government, along with budget constraints, has led to mental health services being poorly resourced.
“With a developing employment profile of a non-specialised and inexperienced mental health workforce, the level of safety for clients and staff is now at a critical level.”
Rather than addressing the issues, the government appears to have stepped back from its overall responsibilities and allowed local health districts to make decisions driven by strict budget constraints, the submission says.
“This has forced LHDs to resort to stopgap, low-cost measures in order to remain in budget at the cost of evidenced-based best practice that ensures better safety of clients.”
NSWNMA supports minimising seclusion
It says the union supports the work of many agencies to minimise the use of seclusion nationally in line with international trends and “best practice principles for patient centred care, trauma informed care and crisis prevention strategies”.
“Patient and staff safety has always been a priority of the NSWNMA and our members, along with evidence-based clinical practice that provides best care for the individual.
“Seclusion and restraint events hold many risks and appropriate measures to help reduce the number of seclusion and restraint episodes will also reduce the exposure of clients and staff to the associated risks.”
The submission points to research showing a small number of high risk clients are involved in most seclusion episodes.
“This research indicated that 84 per cent of episodes had harm to others as the reason for seclusion and with 20 per cent of patients accounting for 70 per cent of the hours for seclusion.”
The submission argues that seclusion must remain an option and is a necessary last resort to ensure optimum safety.
“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.”
Loss of experience
The submission calls on the government to prioritise the recruitment and retention of suitably qualified mental health nurses.
Budget constraints have had a detrimental effect on staffing levels and skill mix in mental health units and community mental health services, it says.
The system has failed to acknowledge the competency, education and experience of specialist mental health nurses and ignored their calls for interventions that would improve service delivery.
This has led to them moving to other areas of health care or leaving the profession altogether.
It says managers of mental health services often have no mental health nursing background.
A number of LHDs no longer require mental health experience and qualifications when advertising for staff.
“With this acute decline in a qualified and highly experienced specialist mental health nursing workforce and an aging workforce retiring from the profession, we now have a generation of less experienced junior nurses that have inadequate mentorship and role modelling available for them to learn from.”
Report by December
The NSW government has announced it will examine the state’s mental health system via a parliamentary inquiry and a review by an “independent” panel led by chief psychiatrist Murray Wright.
The government says the parliamentary inquiry will look at “all aspects” of mental health care while Dr Wright’s panel will investigate the use of seclusion, restraint and observations.
The review will “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”.
The panel will visit NSW 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”.
The review panel is to release its report by December. Other panel members are:
- Kevin Huckshorn, CEO, Huckshorn and Associates
- Karen Lenihan, NSW Principal Official Visitor
- Julie Mooney, Executive Director of Nursing and Midwifery for Southern NSW LHD
- Robyn Shields, Deputy Commissioner at the NSW Mental Health Commission
- Jackie Crowe, Deputy Commissioner of the Australian Mental Health Commission.
The NSWNMA submission on seclusion and observation is available online: