Report highlights major concern over seclusion and restraint practices in NZ

A mental health expert has called for an increase in the availability and use of Māori approaches when dealing with mental health patients to help reduce the use of seclusion and restraint.

Robyn Shearer, Chief Executive of Te Pou o te Whakaaro Nui says an independent report released by the Human Rights Commission titled Thinking Outside the Box – A Review of Seclusion and Restraint Practice in New Zealand clearly highlights the detrimental impact seclusion and restraint can have on patients.

Shearer says, “Seclusion and restraint are traumatizing experiences. We know it causes harm. We need to focus on how we can eliminate the use of this, and ultimately stop doing this practice.”

The report compiled by international expert Dr Sharon Shalev also outlines that Māori are over represented in the use of such practices and while the number of people subjected to this practice has decreased over time by 2%, the prevailing impact on Māori was more severe.

According to the Ministry of Health, statistics between October 2015 to September 2016 the percentage of Māori admitted to inpatient units who experienced seclusion was 10.7% and Pacific people was 9.2% which is significantly higher than "other" ethnicity rates of 5.7%."

Chief Human Rights Commissioner David Rutherford says focus should now be on how the recommendations of the report can be used to reduce the occurrence of seclusion and restraint in New Zealand and in circumstances where it is necessary, to improve practices.  

“The report indicates that seclusion and restraint may not always be used as a last resort option, as required by international human rights law, and several of the rooms and units being used do not provide basic fixtures such as a call-bell to alert staff, a toilet, or fresh running water,” says Rutherford.

Shearer believes one of the key ways to begin addressing the issue is increasing the availability of taking Māori approaches to working with people including whanaungatanga (relationships) and manaakitanga (hospitality) and by ensuring a cultural component in the workforce.

“It’s about supporting the cultural Māori approach and integrating whānau centred care. Using cultural specific interventions that may be helpful to preventing the use of seclusion and restraint, particularly involving Kaumātua and Kuia to be active in inpatient unit."

A number of recommendations have been made in the report which include:

  • Stopping the use of equipment such as restraint chairs and restraint beds.  
  • Making sure that rooms and cells are of a reasonable size, are clean, safe, well-ventilated, well-lit and temperature controlled and that basic requirements around access to fresh air and exercise, food and drinking water are always be met.  
  • Decommissioning facilities that are not fit for purpose.  
  • Ensuring all cells/rooms are equipped with a means for attracting staff attention  
  • Thorough records and data are kept, indicating start and end times of seclusion and restraint periods and any efforts at less restrictive methods, and regularly analysed for trends in ages, ethnicities and gender.