Building collaborative cultures of care

within NSW mental health services

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NSW Health is committed to improving the outcomes and experiences of care for people with lived experience of mental health issues.6

The NSW Ministry of Health has committed to preventing and eliminating the use of restrictive practices (seclusion and restraint) in NSW Health services, including mental health units and emergency departments. This has been supported by changes to legislation, policy and clinical practice.7

People with lived experience and caring, families and kinship groups advocate that restrictive practices are not beneficial, often infringe on human rights and compromise the therapeutic relationship between the consumer and the clinician.

Seclusion in NSW mental health facilities

The use of seclusion in NSW mental health facilities has reduced by 42% since 2010-2011 from 10.2 to 6.0 episodes per 1000 bed days in 2017-18.2228 This is the result of a continual focused effort by government and service providers, with continued engagement and advocacy by people with lived experience, families, kinship groups and carers.

There is room for improvement, as eight restraint and six seclusion events were recorded per 1,000 bed days in NSW in 2017-18.12

Service reform and quality improvement

Service reform and quality improvement in the prevention and elimination of restrictive practices can be achieved by incorporating multi-interventional approaches which include building environments that foster collaboration between people who use services, their supporters and staff.

Cumulative efforts across a number of areas, from systemic organisational changes to changes in daily care approaches will result in transformative change to environments of care, workforce, and experiences of people with lived experience and caring, families and kinship groups.

Through a collaborative process of exploration, investigation and co-design with people, their families, kinship groups and carers, together with mental health organisations, service providers, the ACI has identified:

  • key principles from the Mental Health Commission of NSW’s Lived Experience Framework, encouraging lived experience across mental health and social services systems to be embedded in NSW healthcare services
  • key principles from the ACI Guide to Build Co-design Capability, to guide the capabilities, demonstrated behaviours, key actions and service enablers that support co-design to occur successfully at individual and organisational levels
  • care and organisational approaches to improve active collaboration
  • strategies to transform principles into actions
  • practical examples of these strategies in practice, and
  • helpful resources.34

Future priorities

Further work should be done to eliminate the use of seclusion and restraint in NSW acute mental health units and emergency departments.

There is an emerging understanding of the complexity and multi-factored nature of conflict and containment when a person is very unwell. This includes personalised therapeutic approaches that reduce conflict and harm, and lead to safer environments. A culture which supports and enables working in partnership in all aspects of health care from individual service provider to unit, service and organisational levels is required.

Broader collaboration models, including co-design and co-production, should extend to systems of care and service improvement.22

Restrictive practices

The NSW Ministry of Health has committed to preventing and eliminating the use of restrictive practices. Restrictive practices can be a traumatising experience for consumers, carers, families and staff. During the NSW Health 2017 review, consumers and carers shared experiences of services that showed a lack of compassion and humanity, and increased their mental distress.8 Restrictive practices have no proven therapeutic benefit and may pose a serious risk to safety to people with lived experience and staff when restraint and seclusion is used.78