BEST PRACTICE IN THE REDUCTION AND …

1 best PRACTICE IN THE REDUCTION AND elimination OF seclusion AND RESTRAINT seclusion : TIME FOR CHANGE 1 best PRACTICE IN THE REDUCTION AND elimination OF seclusion AND RESTRAINT seclusion : TIME FOR CHANGE best PRACTICE IN THE REDUCTION AND elimination OF seclusion AND RESTRAINT seclusion : TIME FOR CHANGE i Citation: O Hagan M, Divis M, Long J. (2008). best PRACTICE in the REDUCTION and elimination of seclusion and restraint; seclusion : time for change.

2 Auckland: Te Pou Te Whakaaro Nui: the National Centre of Mental Health Research, Information and Workforce Development. Published in April 2008 by Te Pou o Te Whakaaro Nui: the National Centre of Mental Health Research, Information and Workforce Development. PO Box 108 244, Symonds St, Auckland 1150, New Zealand ISBN 978-0-9582904-1-8 This document is available on the Te Pou website: best PRACTICE IN THE REDUCTION AND elimination OF seclusion AND RESTRAINT seclusion : TIME FOR CHANGE ii EXECUTIVE SUMMARY Reducing use of seclusion and restraint in mental health service inpatient settings has gained wide national and international interest.

3 A review of the literature has identified a number of best practices for reducing and eliminating use of seclusion and restraint. This document outlines these best practices and discusses the new draft Health and Disability Sector Standards that govern use of seclusion and restraint in New Zealand. Specific advice on best PRACTICE for working with Maori and other ethnic groups is required to support change in this area. best PRACTICE Initiatives that Reduce and/or Eliminate Use of seclusion Researchers have consistently reported a number of best practices based on analyses of successful seclusion and restraint minimisation efforts.

4 best practices that contribute to seclusion and restraint REDUCTION include; a national direction that supports seclusion and restraint REDUCTION and elimination efforts, active, committed and high profile organisational leadership and oversight, and an organisational culture that embodies recovery oriented approaches such as trauma informed care. Workforce development is another crucial aspect of successful REDUCTION efforts and includes recruitment, education, supervision and staff involvement initiatives.

5 Further best PRACTICE methods that support REDUCTION include service user development and participation, for example, through provision for feedback and employment in advisory, educator, peer support and advocate roles. Milieu management and use of practical tools, such as; provision of meaningful activities, an atmosphere of listening and respect, crisis prevention planning, violence and trauma assessments, behavioural coaching, de-escalation and sensory modulation also support REDUCTION in use of seclusion and restraint.

6 Effective debriefing and collection and use of information are also essential for seclusion and restraint REDUCTION . seclusion REDUCTION Training Packages Two training curriculum developed in the United States incorporate a range of these best - PRACTICE methods. The two packages are: NASMHPD (National Association of State Mental Health Program Directors - Training Curriculum for the REDUCTION of seclusion and Restraint) or SAMHSA (Substance Abuse and Mental Health Services Administration - Roadmap to seclusion and Restraint Free Mental Health Services) (SAMHSA 2007; NASMHPD 2006) It is recommended that these curricula are adapted for use in New Zealand.

7 best PRACTICE IN THE REDUCTION AND elimination OF seclusion AND RESTRAINT seclusion : TIME FOR CHANGE iii CONTENTS EXECUTIVE 1. PURPOSE AND 1 2. DEFINITIONS OF seclusion AND RESTRAINT .. 1 1 1 3. NZ CONTEXT OF seclusion AND RESTRAINT .. 1 NATIONAL DIRECTION AND 1 HEALTH AND DISABILITY SERVICES (RESTRAINT) PREVENTING HARM TO SERVICE USERS AND 4. SUMMARY OF THE LITERATURE .. 4 5. practices THAT REDUCE AND ELIMINATE seclusion AND NATIONAL 6 ORGANISATIONAL LEADERSHIP AND 6 ORGANISATIONAL WORKFORCE 8 SERVICE USER DEVELOPMENT AND 9 PRACTICAL PREVENTION 9 INFORMATION COLLECTION AND 12 12 13 6.

8 TRAINING 13 NASMHPD .. 13 7. RECOMMENDATIONS ..14 8. SUMMARY AND WHERE TO FROM HERE: THE seclusion : TIME FOR CHANGE PROJECT .. 15 17 APPENDIX: LITERATURE CATEGORIES ..20 best PRACTICE IN THE REDUCTION AND elimination OF seclusion AND RESTRAINT seclusion : TIME FOR CHANGE 11. PURPOSE AND METHOD The purpose of this paper is to identify, through a review of literature, best practices in the REDUCTION and elimination of seclusion and restraint in mental health inpatient settings.

9 This paper includes a review of the current NZ context and analyses the literature on best practices and its relevance to New Zealand. Recommendations for adopting and adapting US training packages for the New Zealand environment follow the analysis. Finally the paper outlines the seclusion : Time for Change project. Te Pou carried out a literature search on the REDUCTION and elimination of seclusion and restraint in mental health services. We are confident that the major literature was identified.

10 However, we were unable to access some articles and there may be other relevant literature that was not traced. 2. DEFINITIONS OF seclusion AND RESTRAINT Restraint The Health and Disability Restraint Standard defines restraint as the use of any intervention by a service provider that intentionally removes the normal right to freedom for the service user (Standards NZ, 2007). The actions of a service user are controlled either through bodily force (physical restraint), with the assistance of an object (mechanical restraint) or by limiting their normal access to an environment (environmental restraint).