Showcasing: Therapeutic Environments Capital Works Program at Nepean Hospital
Nepean Blue Mountains
Nepean Blue Mountains Local Health District
Living Well Domain
Putting people first
Reducing and eliminating seclusion and restraint in hospital settings requires several quality and practice improvements, of which one is improving the therapeutic environment of the ward. By improving the environments of mental health inpatient units, spaces are created that are safer and more welcoming, and which encourage positive relationships between patients and staff.
The NSW Government funded a Mental Health Therapeutic Environments Minor Capital Works Program to assist Local Health Districts to undertake capital works upgrades to improve the design of their mental health inpatient units and to support the reduction of the use of seclusion and restraint. Seclusion is where an admitted patient is placed in a room, alone, from which they cannot freely exit, and restraint is where a person’s freedom of movement is restricted through chemical or physical means.
The Nepean Blue Mountains Local Health District (NBMLHD) project began in July 2018 and was co-designed with people with lived experience of mental health issues and people in caring roles. The project’s aim was to design improvements to the Acute and High Dependency Mental Health Units at Nepean Hospital, and the Blue Mountains Mental Health Unit at Katoomba, to create a more engaging and therapeutic environment.
A $1.5 million grant was provided by the Ministry of Health as part of the 2018/19 Mental Health Therapeutic Environments Minor Capital Works Program. The project is due for completion in late 2019.
Eliminating or reducing practices that are not therapeutic and contribute to the trauma experienced by patients is well-recognised challenge. Most people admitted to mental health units have a history of trauma. Secluding people or restraining them while they are in hospital adds to this trauma and makes the journey to recovery more challenging.
The mental health sector in NSW is working towards eliminating the use of seclusion and restraint, which has been reflected in changes to legislation, policy and clinical practice.
To assist the Mental Health Units to reduce and eliminate the use of seclusion and restraint, extensive work and resources are needed to ensure the physical space better meets the mental health and wellbeing needs of people with lived experience of mental health issues, people in caring roles and staff.
Co-design principles were fundamental to the project, where people with lived experience of mental health issues and those in caring roles were key partners in guiding and shaping the proposed designs. A project users group was established for the co-design process including people with lived experience of mental health issues, peer workers, nursing staff and managers and allied health staff.
Key features designed for the units include:
- A transition space designed to ease the fear people may feel when entering the mental health units at Nepean Hospital.
- Well-resourced sensory rooms containing weighted toys and blankets and access to music. The rooms will provide a comforting and calm environment purposefully designed to help people self-regulate strong emotions and manage their distress.
- Other features, such as a dedicated television spaces, redecorated family rooms, an active courtyard and a passive garden space designed to provide opportunities for meaningful activity and social connection.
The renovations underway are informed by the participation of people with lived experience of mental health issues and those in caring roles through the co-design process. By providing a more therapeutic environment the NBMLHD mental health service anticipates it will be better able to provide a more positive inpatient environment and meet the needs of the local community who require hospital admission.
It is also hoped that the project will serve as a best practice model for other mental health units once complete.
i. Kezelman, C., & Stavropoulos, P. (2012). Practice guidelines for treatment of complex trauma and trauma informed care and service delivery. Retrieved from https://www.blueknot.org.au/resources/Publications/Practice-Guidelines
ii. Cusack, P., Cusack, F. P., McAndrew, S., McKeown, M., & Duxbury, J. (2018). An integrative review exploring the physical and psychological harm inherent in using restraint in mental health inpatient settings. International Journal of Mental Health Nursing, 27 (3), 1162-1176.
iii. Van Der Kolk, B. A. (2015). The body keeps the score. London: Penguin Books.