New projects seek to eliminate seclusion and improve service transitions for mental health consumers

Two new national projects are being introduced that will seek to improve the quality and safety of mental health and addiction services delivered nationwide.

The Pathways to Eliminate Seclusion by 2020 collaborative is being led by the Health Quality & Safety Commission and Te Pou o te Whakaaro Nui (Te Pou). Seclusion is when someone is confined to a room alone for a period of time, from which they cannot independently exit. Globally, there is evidence that seclusion causes harm to consumers who receive it, and it is recognised as contravening basic human rights.

From March 2018 the Commission’s mental health and addiction (MHA) programme team will work with Te Pou, the National Key Performance Indicator (KPI) Programme, service providers, consumers and their whānau/families to work towards elimination of the practice within New Zealand by 2020.

There has been a significant reduction (65 percent) in the use of seclusion in New Zealand since 2009, due to the work of Te Pou, the National KPI group and others. However a continued focus is needed across the sector to sustain those reductions and to accelerate progress towards the elimination of seclusion.

Dr Clive Bensemann, clinical lead for the Commission’s MHA programme, says seclusion can be extremely traumatic. “As well as causing trauma in itself, for some people it can actually trigger the trauma and abuse experiences of the past.

“People deserve care that is pain-free and without seclusion and we are confident the new collaborative will support providers to develop alternative pathways of care that are safe and effective for both consumers and staff.”

Work is expected to begin in March 2018 and the national collaborative will adopt a quality improvement approach to eliminating the need for seclusion and increasing safety.

DHBs will be invited to participate and put forward clinicians, consumers and whānau/families to attend regionally-based learning opportunities and co-design workshops. With Māori more likely to experience seclusion than non-Māori, there will be a strong focus on ensuring culturally safe approaches with Māori mental health consumers and their whānau.

The second initiative, Improving Service Transitions, will begin in June 2018 to address the current variation of service transitions across the country. A service transition is the process of managing the ongoing care for a MHA consumer who is transitioning between different health care providers or locations.

Service transitions in the MHA sector are multiple and they are recognised as a potential risk to consumers, and their whānau/families. Some serious adverse events are thought to be linked to a failed service transition.

The Commission will work with stakeholders from across the wider MHA sector to support a quality improvement approach to improving service transitions. An evidence review is already underway to confirm what is known nationally and internationally on improving service transitions.

The involvement of consumers and whānau/families at all levels of planning and design for both projects is crucial to their success, says Shaun McNeil, National Consumer Engagement Advisor for the programme.

“Listening to the stories of consumers who have experienced failed service transitions or who have experienced the trauma of seclusion will be central to enriching and informing each programme of work.

“By hearing how these experiences really affect consumers, and working with them at every level of project design, we will be able to take the right steps to ensuring our work is promoting healing, providing alternatives to seclusion and achieving improvements in care, particularly at the point of transition.”

The Commission’s MHA quality improvement programme was established in July 2017, to work with consumers, their whānau/families and service providers to improve mental health and addiction services.

For Q&A about these new programmes, click here (251 Kb, pdf).

For more information about the programme, click here.