Ruth Vine – Executive Director, North West Mental Health Services - PowerPoint Presentation

Ruth Vine – Executive Director, North West Mental Health Services Tracy Beaton – Chief Practitioner, Department of Health and Human Services

National … to state governance …

2005 – 2015 – National work 1 st National Meeting on Seclusion and Restraint in 2005 Beacon demonstration project initiated 2006Seclusion rates added to the National KPIs in 2007Continuing targeted activity by all jurisdictions 2007-2011Backed by 10 national forums National processes now established for reporting seclusion data

Focus on Seclusion and Restraint 2 nd , 3 rd and 4th Plan (2009 – 2013)COAG National Action PlanRevised National MH Policy (2008) April 2010: National Health reforms overtook this with a broader commitment, across the whole health sector National Health Performance Authority being established Small number of mental health indicators, but likely to expand

The National standards for mental health services 2010 require that the activities and environment of mental health services are safe for consumers, carers, families, visitors, staff and the community. That services reduce and where possible eliminate the use of restraint and seclusion within all mental health service settings National Mental Health Commission (NMHC) – National Seclusion and Restraint Project continues to promote best practice in reducing and eliminating the use of seclusion and restraint of people with mental health issues

And there is more … Significant changes in where and how mental health services are delivered Most States have reviewed and reformed their MH legislation ‘National’ Mental Health Commission. A number of States also created MH commissions Australia has ratified the UN Convention on the Rights of Persons with Disabilities Services learning to work more closely and to seek advice and guidance from people with lived experience

State Work Most States carried out projects in addition to Beacon. Victoria – 2007 ‘Creating Safety’. $350k granted by the VQC to support a training program, leadership and organisational change. Involved trainers from the USA and reached over 2000 staff (including people from other States)

Our Data

Reducing Restrictive Interventions Mental Health State-wide Initiatives - Reducing Restrictive Interventions (RRI) initiative - Sensory modulation - Safewards Policy Context Reform of Victoria’s Mental Health Act National standards for mental health services 2010 National safety priorities in mental health: a national plan for reducing harm Creating safety - Addressing restraint and seclusion practices project report 2009 National mental health seclusion and restraint project 2007–2009 Victorian Mental Health Workforce Strategy Framework for recovery-oriented practice 2011 Providing a safe environment for all - Framework for reducing restrictive practices 2013 KPIs set in the Statement of Priorities for boards

Reducing Restrictive Interventions program March 2014 - $2,050,000 allocated to RRI LAPs outlining strategies to reduce the use of restrictive interventions, including 7 seeking to implement Safe-wards Approved budget distribution RRI local action plans Sensory modulation equipment Safewards trial in seven services $820,000 $230,000 $1,000,000

RRI Framework and LAPS

Sensory Modulation Almost three quarters of services requested sensory modulation equipment in their LAPs A training program was developed and delivered, teaching people to train others in how to use sensory equipment and work with the individual and their needs We are interested in the impact of sensory modulation? Feedback from services will be sought re: What equipment was purchased Where the equipment is being used (unit type, patient population) What support staff have received to use the equipment What have the outcomes been since the equipment has been made available (how to measure this?)

Safewards Seven services mentioned Safewards in their LAPs Safewards … …aims to reduce conflict within mental health services in order to create a safe environment for all …identifies and addresses causes of behaviours in staff and consumers that may result in harm, such as violence, self-harm or absconding Originating in the UK, developed from a broad body of evidence A randomised controlled trial reported a decline in conflict at each experimental site

Local solutions to reducing restrictive practices Common Factors Governance – strong and engaged leadership, clear processes and accountability. Engagement of all staff but especially medical and nursing Requirement for audit and review of individual and collated incidents, especially where there is extended duration or multiple episodes Repeated training- involve those with lived experience Use of data to benchmark between like services, and over time. Having data published or included in service agreements adds weight.Amenity and alternatives – spaces, quiet rooms, distraction techniques

Pharmacological management of acute arousal - ? Chemical Restraint Rapid sedation, where it is used in mental health emergency situations as an alternative to mechanical/ physical restraint, is considered restraint by consumers, carers and others, and carries its own risk of adverse events. No definitive agreed definition of restraint that includes rapid sedation. Incidents and adverse medication events related to sedation, however, are considered adverse drug events.

Known adverse events with seclusion and restraint Dehydration Choking C irculatory and skin problemsLoss of muscle strength and mobilityPressure soresIncontinence and injury from associated physical/ mechanical restraintIncreased psychological distress In rare circumstances, death

A Cautionary Note Reduction in use and duration of restrictive practices has been successful and in most services sustained. Recent data suggests an increase in some services – related to new admissions, frequent use of crystal meth, high levels of aggression Pressure for throughput – too many new/unknown patients Small and cramped ICA areas not always suitable – mix of vulnerability and aggression EDs also reporting increased levels of occupational violence and use of restrictive interventionsMay need to revisit need for assessment units where there is access to safe use of medication, capacity to resuscitate.

Future Directions Influenced by funding and service development ? Model of smaller generalist units co-located with general hospitals still the best one ? Need for shift in model in relation to dual diagnosis, mixed gender Most important to make provision of safe and therapeutic environment a central goal – may compete with demand and efficiency

THANK YOU ANY QUESTIONS ?