Cover of seclusion review report
18 December 2017

A new review of the way seclusion and restraint are used in in-patient mental health facilities and emergency departments shines a light on outdated and harmful practices and points the way to a more effective and humane system, Acting NSW Mental Health Commissioner Karen Burns said today.

The report, Review of seclusion, restraint and observation of consumers with a mental illness in NSW Health facilities, was released today by the NSW Government. The report was authored by Chief Psychiatrist Dr Murray Wright, who was appointed to lead the review after details surrounding the death of patient Miriam Merten in 2014 came to public attention in May.

Ms Burns said the Commission was extremely pleased to see a straight talking report, with recommendations which do not shy away from the impact of seclusion and the trauma it inflicts on individuals.

“The Commission unequivocally supports the reduction and elimination of seclusion and restraint practices in mental health facilities. We endorse the 19 recommendations released today, which acknowledge people’s harmful experiences of coercive practices, and set in place steps to enable the reduction and elimination of these traumatic events,” Ms Burns said.

“We also welcome the $20m investment to ‘improve the therapeutic environment inside acute mental health units’. For this to be achieved, people with lived experience of mental health issues including peer workers will need to be included in all planning and decisions.”

Ms Burns said the Commission will monitor the NSW Government’s roll out of the funding and how the recommendations are implemented.

“We call on the NSW Government to ensure there is accountability and transparency regarding the implementation of the review’s recommendations. The community needs to have absolute trust that when they or a loved one needs care for an acute mental health issue, they will be safe and respected, and not re-traumatised or harmed in any way.”

Ms Burns said she was pleased to see that many of the report's recommendations pointed to a future in which people who have experienced negative practices have a role in improving the system. 

“We should expect to see people with experience of mental illness exercising decision making and influence at every level of a mental health service. That includes being involved in decisions about their own treatment, but – as emphasised in the recommendations – it also means being involved in delivering care to others as a peer worker and in co-designing safe environments and services that promote recovery.

“I would add that it is vital that people with lived experience of mental illness be involved in evaluating and monitoring how the recommendations of this review are taken up.”

Ms Burns welcomed the recommendation for more authority and responsibility for Directors of Mental Health, a recommendation the Commission made in Living Well, and the report’s overall emphasis on the need for a respectful, qualified and motivated mental health workforce in NSW.

“The more we can establish a culture of care, clinical excellence and safety in our mental health system, the more people with mental illness, their families and staff will all benefit.”

For further information about the review, please visit NSW Health’s website. NSW Deputy Mental Health Commissioner Robyn Shields was a member of the expert review panel.

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Last updated: 18 December 2017