Mental Health Safety And Quality In NSW
Mental Health Safetyand Quality in NSW:A plan to implement recommendations of the Reviewof seclusion, restraint and observation of consumerswith a mental illness in NSW Health facilitiesMay 2018
NSW Ministry of Health73 Miller StreetNORTH SYDNEY NSW 2060Tel. (02) 9391 9000Fax. (02) 9391 9101TTY. (02) 9391 9900www.health.nsw.gov.auProduced by: NSW Ministry of HealthThis work is copyright. It may be reproduced in whole or in part for study or trainingpurposes subject to the inclusion of an acknowledgement of the source. It may not bereproduced for commercial usage or sale. Reproduction for purposes other than thoseindicated above requires written permission from the NSW Ministry of Health. NSW Ministry of Health 2018SHPN (MHB) 180219ISBN 978-1-76000-858-1Further copies of this document can be downloaded from the NSW Health websitewww.health.nsw.gov.auMay 2018iiNSW Health
SUMMARYThe NSW Government has made a major commitment to preventing the use of seclusion and restraint inNSW Health acute mental health units and emergency departments.Planning and implementation of seclusion and restraint prevention initiatives is already underway, with animmediate NSW Government commitment of 20 million to improve the therapeutic environment in NSWHealth acute mental health facilities.The tragic death of Ms Miriam Merten in Lismore was the catalyst for an independent review into the use ofseclusion and restraint in NSW Health facilities. The Review team reached out to health professionals,consumers and their support networks to determine what changes should occur in our health system.The Review reported in December 2017 and the NSW Government has accepted all 19 recommendations.These recommendations are based on findings that were evident across the mental health system.Improvement is required in all mental health units and declared emergency departments in NSW, but thescope of recommendations will require system-level change in a range of areas beyond the operations ofmental health units and emergency departments, including workforce, culture and leadership, andgovernance.Working with health professionals including professional bodies such as the NSW Nurses and Midwives’Association, consumers, carers, peak mental health organisations, Official Visitors and the Mental HealthCommission of NSW is crucial to successful implementation.Consumerand CarerParticipationBuilt re &LeadershipDataAccountability &GovernanceNSW Health1
WHY IS NSW HEALTH FOCUSINGON SECLUSION AND RESTRAINT?The reduction and, where possible, elimination,of restrictive practices in mental health services isan important issue for NSW Health and a priorityat both national and state levels. NSW Health hastaken significant action to address restrictivepractices and the rate of seclusion in NSW acutemental health units has reduced by over 30 percent since 2010-2011.The 2017 Review raised the primary question ofwhether our system has the right vision and goals,properly supported by effective strategies, policiesand resources, to enable the sustained preventionof seclusion and restraint.During the Review, consumers, carers and familiesshared stories about their distressing experiencesof restrictive practices. Their experiences wereconsistent with international literature about therisks of seclusion and restraint in health settings.Many consumers have negative experiences ofseclusion. One international study reported thatconsumers who experienced seclusion felt angry,upset, lonely, abandoned, scared, vulnerable,humiliated, worthless, depressed, punished,trapped and bored.Having asked so many people to visit and revisittheir own experiences of restrictive practices, it isimperative that this information underpinssustainable changes to improve our systems ofcare. NSW Health is committed to working withconsumers and carers to provide high qualitymental health care that is trauma-informed,recovery focused, and truly aligned to our COREvalues of Collaboration, Openness, Respect andEmpowerment.The 19 recommendations will guide planning andthe development of safe, contemporary andcompassionate services with the capacity to evolveand improve. This is an opportunity for services toreview their models of care and to realign them tostrengthen efforts to prevent seclusion andrestraint.2WHAT WILL BE THE OUTCOMESOF IMPLEMENTING THERECOMMENDATIONS?NSW Health will provide safe, respectful, traumainformed and recovery-oriented care toconsumers.Four outcomes of seclusion and restraintprevention action have been identified:1. Seclusion will be less frequent, duration ofseclusion will be shorter, and the likelihood ofseclusion is reduced2. Patient experience of mental health care will beimproved3. Carer experience of mental health care will beimproved4. NSW Health clinical staff will be more engagedin consumer-focused mental health careWHAT ACTION WILL BE TAKENTO PREVENT SECLUSION ANDRESTRAINT?Action is being taken across seven key domains:1. Culture and leadership2. Patient safety3. Accountability and governance4. Workforce5. Consumer and carer participation6. Data7. The built and therapeutic environmentThis state-wide implementation plan will besupported by local health district (LHD) andspecialty health network (SHN) seclusion andrestraint prevention action plans to ensure acohesive and comprehensive approach to change.NSW Health will work with peak mental healthconsumer and carer organisations so that actionsare considered in collaboration with those who areexperts by experience. Consumers and carers whohave a lived experience of mental illness are keypartners for LHDs and SHNs. It is essential that thehealth system uses this knowledge to inform andenhance the actions taken to improve mentalhealth services. NSW Health will also work closelywith professional bodies such as the NSW Nursesand Midwives’ Association.NSW Health
While many actions will focus on acute mental health facilities and emergency departments, significantchange needs to occur at a system level. Accountability at the highest levels of the health system, a focuson culture and leadership, new forms of data and reporting, workforce development, and more openengagement of consumers, carers and families will support system-level change for mental health care inNSW.HOW CAN CONSUMERS, CARERS AND FAMILIES BE INVOLVED?A key principle in NSW Health’s action to prevent seclusion and restraint of mental health consumers is toengage consumers, carers and their families in co-designing prevention initiatives.NSW Health will collaborate with peak mental health organisations such as Being and Mental Health CarersNSW to ensure the expertise of consumers, carers and families with a lived experience of mental illness iscaptured and reflected throughout implementation.Every LHD and SHN will incorporate consumer, carer and family co-design into their prevention actionplans. To be involved at your local area, please contact your LHD or SHN www.health.nsw.gov.au/lhdACTIONS NSW HEALTH WILL TAKERECOMMENDATIONACTIONMILESTONE1.1 Embed the NSW Health Leadership Frameworkfor all NSW Health mental health staff at allstages of their career (with mental health staff asthe initial priority)Oct-182.1 Implement a statewide mental health patientsafety programJun-193. The Director of Mental Health shouldbe a member of the district or networksenior executive and report to theChief Executive3.1 Review senior executive structures and includeDirectors of Mental Health as members of thesenior executive and report to Chief ExecutiveJul-184. District and network clinicalgovernance processes should includeemergency department and mentalhealth seclusion and restraintperformance togetherJan-194.1 Review existing seclusion and restraint clinicalgovernance processes and include accountabilityfor both emergency departments and mentalhealth units5. All mental health inpatient servicesmust have 24-hour, everyday on-sitesupervision from accountablemanagement representatives. Thissupervision must include in-personrounding on every shift5.1 Review afterhours management practices andensure all mental health inpatient services have24/7 on-site supervision from account ablemanagerial staff, including in-person supervisionvisits to units on every shift6. NSW Health should have a single,simplified, principles-based policy thatworks towards the elimination ofseclusion and restraint6.1 Develop a single, culturally appropriate NSWApr-19Health policy towards the elimination of seclusionand restraint that recognises human rights andtrauma-informed care principlesCulture and leadership1. NSW Health must establish and adoptan integrated leadership developmentframework applicable to all staff at allstages of their careerPatient safety2. NSW Health must adopt a mentalhealth patient safety program,informed by contemporaryimprovement scienceAccountability and governanceNSW HealthJun-183
RECOMMENDATIONACTIONMILESTONE7. There should be an immediatereinvigoration of the implementationof the NSW Health Smoke-free HealthCare Policy (PD2015 003), whichincludes increasing the knowledge anduse of nicotine replacement therapy7.1 Use the new Smoking Cessation Framework forNSW Health Services to overcome barriers tothe delivery of effective smoking cessationinterventions for mental health consumers indeclared emergency departments and mentalhealth facilitiesOct-188.1 Finalise and implement the NSW StrategicFramework for Mental Health and Workforce Plan2018-2022Jul-188.2 Include culturally appropriate, recovery-oriented,trauma-informed care principles training for allmental health staffFeb-198.3 Provide ongoing clinical supervision to all mentalhealth staff to ensure learning is transferred topracticeApr-199.1 Ensure statewide systems and training inrecruitment and performance developmentsupport the appraisal of NSW Health COREvalues of Collaboration, Openness, Respect andEmpowerment.Mar-199.2 Performance appraisals for all staff working withpeople with a mental illness include culturallysensitive, recovery-oriented and traumainformed care principlesApr-19Workforce8. NSW Health should develop andimplement minimum standards andskill requirements for all staff workingin mental health9. NSW Health should ensure thatrecruitment and performance reviewprocesses include appraisal of valuesand attitudes of all staff working withpeople with a mental illness10. The peer workforce should be10.1 Develop a NSW Peer Workforce Framework todeveloped and professionalised, with theguide development and support thesame supports and accountabilities asprofessionalisation of the peer workforceother disciplines. The number of positions 10.2 Recruit and train new peer worker roles undershould be increased, however only afterthe Mental Health Reformthe supports and accountabilities are inplaceJul-19Jul-18Consumer and carer participation11. Meaningful engagement with11.1 Strengthen consumer and family engagement inconsumers and their families shouldassessment and care planning, informed by theoccur in assessment and care planning,Mental Health Commission of NSW’s Livedparticularly in developing personalExperience Framework (in development)plans to prevent the use of restrictivepracticesApr-1912. Consumer and carer co-design andsystematic engagement should occurat all levels of the health service12.1 Develop resources to support successful mentalhealth co-design processes, informed by theMental Health Commission of NSW’s LivedExperience Framework (in development)Apr-1912.2 Routinely include consumers and families in keycommittees, projects and workgroupsJun-1913.1 Use local data to inform quality improvement toreduce seclusion and restraintApr-1913.2 Further develop state level reporting of seclusionand restraint dataMay-19 Collect and report seclusion and restraint datafrom declared emergency departmentsJun-19Data13. NSW Health should improve thetransparency, detail, and frequency ofpublication of seclusion and restraintdata at the state and local level14. The NSW seclusion and restraint data14.1collection and reporting should includedeclared emergency departments4NSW Health
RECOMMENDATIONACTIONMILESTONE15. All emergency departments shouldhave clinical pathways for peoplepresenting with mental health issuesthat are reflective of their needs. Thereneeds to be a pathway that does notinclude the use of safe assessmentrooms15.1 Ensure clinical pathways in emergencydepartments reflect the needs of people withmental illness, including alternatives to the useof safe assessment roomsJul-1916. There should be an immediate reviewof the design and use of safeassessment rooms using a co-designmethodology16.1 Review the use and design of safe assessmentrooms in emergency departments using aco-design and redesign methodologyFeb-1917. All future capital planning of mentalhealth facilities should includeconsumer co-design and be informedby evidence on preventing seclusionand restraint17.1 All capital planning of mental health facilities isinformed by evidence based principles andclearly demonstrates consumer co-designAug-1818. All acute mental health units anddeclared emergency departmentsshould conduct a review of theirfacilities and implement minor capitalworks and equipment purchases toimprove the therapeutic potential18.1 Using a codesign approach, coordinate theimplementation of minor capital works andequipment purchases to improve the therapeuticenvironment in LHD/SHN mental health facilitiesDec-1819. All mental health units should have amultidisciplinary team with the skills todeliver a therapeutic program andenvironment on an extended-hoursbasis19.1 Ensure multidisciplinary teams delivertherapeutic programs on extended hours basisApr-19The built and therapeutic environmentAdditional supporting actionsIn addition to the actions that will be undertaken against the Review recommendations, two additionalhave been identified to further support local implementation.ACTIONMILESTONEEach LHD and SHN will co-design a culturallyappropriate seclusion and restraint prevention actionplan for their serviceSep-18NSW Health will establish a state-wide seclusion andrestraint prevention community of practice to shareknowledge and refine improvements. Communities ofpractice are groups of people who interact together toaddress a common concern or area of shared interest.Jul-18Local leadershipLHD and SHN seclusion and restraintprevention action plansSupporting positive cultures of careCommunity of practice to preventseclusion and restraintNSW Health5
EXAMPLES OF KEYACTIONS FROM THEIMPLEMENTATION PLANWHEN WILL CHANGES INSECLUSION AND RESTRAINTBE MADE?Recommendation 2 calls for NSW Health to adopta mental health patient safety program, informedby contemporary improvement science.Planning for implementation commenced as soonas the NSW Government adopted all 19recommendations of the Review. This includedconsultation with every LHD and SHN, the NSWMental Health Commission, the Agency for ClinicalInnovation, the Health Education Training Institute,the Clinical Excellence Commission, HealthInfrastructure, the Bureau of Health Information,NSW Ambulance, and other key stakeholdersincluding peak mental health consumer and carerorganisations.To achieve this action, the Ministry of Health andClinical Excellence Commission will collaboratewith partners, including consumers and carers, toidentify the components of a culturally appropriatemental health patient safety program. Work willthen begin to recruit and develop a mental healthpatient safety team and program to support theNSW Health system. This will be aligned to otherpatient safety programs, such as the adult patientsafety and paediatric patient safety programs thatare led by the Clinical Excellence Commission.Developing tools that support mental healthpatient safety will be a key action. To achieve thisthe team will need to collaborate with consumersand carers, as well as health professionals, toidentify what works.While some individual services have made progressin reducing seclusion and restraint, there has notyet been a sustained statewide approach usingimprovement science methods. The mental healthpatient safety program will be informed bysuccessful international examples that haveincluded reduction of restrictive practices as onestream in a comprehensive program to improvecare.Recommendation 18 calls for acute mental healthunits and declared emergency departments toreview their facilities and implement minor capitalworks and equipment purchases to improve thetherapeutic potential.Research indicates that changes to the physicalcharacteristics of the environment have beenassociated with significant reductions in seclusionand restraint. Sensory interventions (such asweighted blankets, changing temperature, light orsound input) can also assist consumers withemotional regulation and result in a decrease inseclusion and restraint. The NSW Government hascommitted 20 million to improve the therapeuticenvironment of NSW mental health facilities.The implementation plan commences in May 2018,with a timeframe of 12 months for delivery of mostrecommendations and the remainder in place byJuly 2019.Progress towards the implementation plan will bemonitored every month, with regular updates tostakeholders and the community aboutachievements and challenges. For ongoingupdates, see www.health.nsw.gov.au/patients/mentalhealthWHO WILL BE RESPONSIBLEFOR CHANGE?Every person in NSW Health will have a role to playin seclusion and restraint prevention, especiallythose working in acute mental health units andemergency departments.Accountability for change is embedded in thestate-wide implementation plan. Chief Executivesof LHDs and SHNs have responsibility for changesin their services. The Ministry of Health isresponsible for driving and monitoring seclusionand restraint reform. Other agencies, including theClinical Excellence Commission and the Agency forClinical Innovation, also have responsibility for keyactions in the implementation plan.Seclusion and restraint prevention implementationwill be reviewed every month at the NSW HealthSenior Executive Forum, which includes all ChiefExecutives of LHDs and SHNs, the pillar agenciesand the Ministry of Health.Each quarter, organisations responsible for eachaction will report on progress through the Ministryof Health to the Minister for Mental Health.6NSW Health
HOW WILL CHANGEBE MONITORED?The implementation plan works towards the goal ofelimination of seclusion and restraint.A performance indicator range below 6.8 episodesper 1000 bed days was set in 2016. To build onprogress, it is time to revise the NSW seclusionperformance indicator to support furtherimprovements.The new indicator range of fewer than 5.1 episodesper 1000 occupied bed days will be implementedthrough the NSW Health Performance Frameworkfrom 2018/19. This change is an ambitious butreachable 25 per cent reduction from the currentindicator range.New and existing sources of data will be used tomonitor progress towards the seclusion andrestraint prevention outcomes.Outcomes measures include:100% of LHDs and SHNs meet key performanceindicators listed in Service Agreement: Seclusion rate of 5.1 episodes per 1,000 beddays Average duration 4 hours per episode Seclusion likelihood reduced as reportedquarterly by InforMHYour Experience of Service (YES) Surveyindicates: Annual increase of 10% or more in thecompletion rate of consumers who havereceived hospital care in the Your Experienceof Service survey 80% or more of mental health consumers ratetheir care experience as very good or excellentin the YES surveyConsistent improvement in NSW’s results fromthe new Mental Health Carer Experience Survey(pending implementation), which willcomplement the existing YES survey forconsumersAnnual increase or no change in the proportionof NSW Health staff employed in mental healthservices that report being engaged in their workin annual Public Sector Commission EmployeeEngagement surveyProgress will be monitored by process measures foreach action in the implementation plan.NSW Health7
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SHPN (MHB) 180219
stages of their career (with mental health staff as the initial priority) Oct-18 Patient safety 2. NSW Health must adopt a mental health patient safety program, informed by contemporary improvement science 2.1 Implement a statewide mental health patient safety program Jun-19 Accountability and governance 3. The Director of Mental Health should
Mental Health, Mental Health Europe NGO and the UK Royal College of Psychiatrists7. "No health without mental health" has also been adopted by the Irish organisation Mental Health Ireland, Supporting Positive Mental Health. Burden of Mental Disorders Mental disorders have been found to be common, with over a third of people worldwide
3.2 european Policy 12 3.4 Happiness and wellbeing debates 14 4.0 Concepts and definitions: what is mental health? 15 4.1 Dual continuum model of mental health 16 4.2 Measuring mental health 17 5.0 Benefits of mental health promotion 19 5.1 Benefits of preventing mental illness 19 5.2 Benefits of promoting positive mental health 22
3.1 Prevalence of mental ill health 9 3.2 Mental health service need 9 3.3 Mental health service provision gap 10 3.4 Housing system and homelessness 10 3.5 Entries into homelessness 11 3.6 Mental health and housing system capacity 12. 4 Links between housing and mental health 13 5 Housing for people with lived experience of mental ill health 16
A mental health policy (1996) and plan (2007-2011) existed. Emergency and disaster plans for mental health did not exist. Legislation A new Mental Health Act 846 2012 was passed in 2012 and was awaiting Government to establish the Mental Health Board. Financing of mental health services Mental health had a ring-fenced budget of 1.4% of
mental health is about much more than mental illness, and that there are significant benefits to be gained by approaching mental health from a public health perspective. Positive mental health, mental wellness and mental health promotion have emerged as the missing pieces in a system that has traditionally been
15099.1 Mental health & Work report:15099.1 Mental health & Work report 7/7/08 16:19 Page 3 BACKGROUND 1 1.1oduction Intr 1 1.2ental Malth he problems and their prevalence 1 1.3ctors Fat tha affect the prevalence of mental health problems 2 1.4ciation Asso between mental health and physical health 2 1.5reatment T and outcomes 2 1.6he T impact and cost of mental health problems 3
Communityed-bas mental health services initiated within 30 calendar days of referral coordinating mental health services with a student's primary mental health care provider and other mental health providers involved in student care. Assisting a mental health services provider or a behavioral health provider as described in s. 1011.62, F.S.,
Astrophysics combines our knowledge of light, chemical reactions, atoms, energy, and physical motion all into one. The things we’re going to study in this unit borders on sci-fi weird, but I assure you it’s all the same stuff real scientists are studying. This unit is broken into three completely separate sections that you can to in any order. Some are easy-and-fun and others are mind .
