Reducing seclusion in mental health units 'unrealistic'


A plan to reduce seclusion in mental health units is being described by one worker as "dangerous" under current staffing levels.

There are renewed calls for an investigation into seclusion practices after a report by the Chief Ombudsman found mentally ill man Ashley Peacock was living in "cruel" conditions at a Porirua facility.

The technique comes under strict regulation in New Zealand and is intended to only be used as a last resort. A national plan to reduce its use was laid out nearly 10 years ago.

But a mental health worker at Lakes District Health Board (DHB), who spoke to Newshub on condition of anonymity, says a move to replace seclusion with "intensive nursing" is putting a strain on resources.

The approach requires two or three staff to work exclusively with an at-risk patient.

Newshub's source says that's led to mental health support workers - who may be lacking in qualifications and experience - being used in place of registered nurses.

"In the push for no seclusion we haven't been properly resourced to handle that intensive nursing," the source says.

"I'm against seclusion but, actually, the real discussion is about the fact that we can't resource anything else. It's unrealistic."

The staff member says inexperienced workers are being put with agitated or dangerous patients, creating "real potential for assault and aggression".

This month, Lakes DHB came under the spotlight for a spike in assaults on its staff.

Figures showed 18 employees were attacked in the first five months of 2016, compared with 20 in all of 2015.

Half of the attacks happened in Rotorua Hospital's mental health unit.

The employee says those figures are "the tip of the iceberg", and many assaults are going unreported due to staff apathy and no follow-up from management.

The attacks on staff range from spitting to strangling, punching and kicking.

In a single weekend this month, eight unreported assaults happened in the unit, the source says.

But Lakes DHB chief executive Ron Dunham says Rotorua Hospital's mental health unit is "regarded as having a good reporting culture".

Earlier this year, the DHB introduced a new electronic system for recording assaults, which has made the process easier.

"All reported assaults are followed up with Health and Safety and the senior clinical management, along with staff involved," says Mr Dunham.

Meanwhile, Mr Dunham says seclusion "should be an uncommon event", and is used "only when there is an imminent risk of danger to the individual or others and no safe and effective alternative is possible".

He says any development of mental health nursing practice is aligned to Ministry of Health directives around reducing seclusion.

But the staff member who spoke to Newshub says the current situation in Rotorua Hospital's mental health unit is unsustainable.

The source says the problem's been caused by chronic underfunding of mental health services, which has led to inadequate staffing.

"We've been told we're at [the quota for full-time employees] but as soon as someone goes off sick, you can't replace them because we don't want to do the extra hours. We're burnt out."

Staff members are being asked to do double shifts, which equate to 17 hours of work, and fatigue is contributing to the dangerous conditions.

Mr Dunham says the unit is "currently fully staffed".

He says where there are resourcing difficulties, there is "an escalation plan" in place.

"There are periods of time when the DHB may not be able to replace skilled and experienced staff with equally skilled experienced staff."

"Mental health support workers are valued members of the nursing team and work under the direction and delegation of a registered nurse."

Mental Health Foundation CEO Shaun Robinson says former Mental Health Commissioner Mary O'Hagan laid out a national guide for reducing seclusion in 2008.

"There's just been far too little progress along that plan, and in fact the sorts of cases that are now coming to public attention show that we're now further back, rather than moving forwards," Mr Robinson says.

"We know what to do - clearly we just lack the resources and the will to do it."

"When it comes to the point where the Ombudsman is investigating mental health services under the auspices of Acts which are used to investigate torture, I don't think many New Zealanders would have difficulty seeing just how wrong that is."