Seclusion and Restraint

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I recently attended the National Seclusion and Restraint Reduction Forum in Canberra, held on the 28th and 29th of November 2013. The Office of Chief Psychiatrist funded my participation with the event. The Forum was titled: “Reducing the trauma with least restrictive practice: Why it matters to walk the talk.” It was an opportunity for people from many areas of mental health service provision throughout Australia, NZ and a guest from the USA to discuss the progress that has been made in the continued reduction in the number of invasive seclusion and restraint episodes, maintaining best practice, quality mental health care.

From my perspective, as a person living with significant mental illness and with experiences of both seclusion and restraint, it is heartening that the reduction of these practices is high on the agenda and the many sessions held over the two days demonstrated how solid progress is being made towards this goal.

The session titled: “Developing Trauma Informed Care” delivered by Gary Parker a Consumer activist and advocate from Kansas USA was for me, amongst the most compelling. His presentation can be viewed at:

http://webcast.gigtv.com.au/Mediasite/Play/40e05eab125846acb860f43d14cd220a1d?catalog=78ae969f-64c2-4b87-87fd-5d40d5fd4b8b.

What he talked about with regards to seclusion and restraint in the mental health system is common knowledge. Most people in the sector know we need trauma informed care, for people who are acutely unwell. We know that restrictive practices can re-traumatise people, that healing happens when people trust and engage meaningfully with others, that feeling heard and validated is essential and that  people are empowered and recognised to be the experts in their own lives. What Gary did particularly well was that he communicated with an obvious passion. His message was that change can and will happen when the mental health system has entrenched champions who celebrate success, who believe in the effectiveness of employing people with lived experience, is genuinely accountable and transparent and has inspiring leadership, commitment and vision.

In essence the two days the presentations delivered messages agreeing that the use of seclusion and restraint:

  • is a failure of the therapeutic process
  • can  be reduced through non-violent crisis intervention training
  • is reduced where staff have time to listen and talk with people under duress and in distress
  • can be the result of an environment which is lacking stimulation, structure and organised activities
  • can be decreased over time through thorough reflective practices and continual improvement
  • should occur with respect and sensitivity for cultural requirements.

My personal hope for the future of mental health services is that an increasing workforce of people with lived experience are employed and integrated as valued members of multi-disciplinary mental health care teams. That there to be the capacity for peer workers to engage meaningfully with patients on admission to hospital, to develop advanced safety plans early on identifying  triggers, wellness strategies, strengths and vulnerabilities. Also, ideally, to be able to orientate people to a comfort or sensory modulation area.

I believe that as a patient, when I feel heard and have a trusting relationship developed with a supportive person on the ward, that personal recovery is advanced and the potential need for restraint or seclusion, much reduced. Systemic bravery is imperative! Leadership needs to embrace change and to value the sense of employing lived experience workers  within multi-skilled teams in acute inpatient settings.

In the words of Winston Churchill:

“Courage is what it takes to stand up and speak; courage is also what it takes to sit down and listen.”

Professor Allan Fels, AO from the National Mental Health Commission invites people to sign a declaration which can be downloaded at:

http://www.mentalhealthcommission.gov.au/news-events/our-news/sign-up-to-the-seclusion-and-restraint-declaration.aspx.

Full webcasts of the forum can be viewed at http://goo.gl/udwGUW.

Sharon Buer

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