Lock-up 'therapy' damaging

By MARTIN JOHNSTON health reporter

The Mental Health Commission wants an end to the practice of locking out-of-control patients in "seclusion" rooms, after its research found the practice can be harmful.

In its latest newsletter, the commission says that on average, the patients put in seclusion rooms spend about 50 hours a month in them.

A commission study found that in 2000/01, 37 per cent of patients in acute mental health units for compulsory assessment and treatment spent at least some time in seclusion rooms.

They are often a form of solitary confinement for patients who are violent or out of control, and frequently contain no more than a bed and sometimes a toilet.

The commission says that for the safety of patients, the use of seclusion should be reduced and eventually scrapped.

Its research report comes amid a mounting number of compensation claims against the Crown for alleged mistreatment - including excessive use of seclusion - in mental hospitals in the 1960s and 1970s. Claims from more than 200 former patients have been lodged with lawyers, and about 70 have so far been filed in the High Court.

Mental health workers yesterday said use of seclusion had fallen and needed to decline further, but this would require more staff.


The report says seclusion has been portrayed as a therapy employing solitude - "calm, serene and contemplative".

"Evidence now suggests that seclusion poses significant risks to service users, including death, re-traumatisation, loss of dignity and other psychological harm."

The patients felt helpless, fearful, angry, depressed and thought they were being punished.

Research on solitary confinement in jails has found it leads to hallucinations, depression and declining mental functioning.

The report says there are three main interpretations of seclusion: as a therapy, as a way of protecting a violent patient and others from him/herself, and as punishment.

The Mental Health (Compulsory Assessment and Treatment Act) sanctions its use for treatment and protection, but not for punishment.

The report says key factors encouraging use of seclusion are poor acute unit design; overcrowding; the high proportion of seriously unwell patients in the units; inflexible or inexperienced staff; under-staffing and high turnover; and a discrepancy between legislation and practice standards over the purpose of seclusion.

The Health Ministry agrees the use of seclusion should be reduced. It plans to gather more data about the practice from health boards and require them to hold staff debriefings after each use of it.

Mental health service user group representative Jim Burdett, of Mind & Body Consultants, said people who had experienced solitary confinement described it as the most traumatic experience they had ever had. Some were subjected to it naked.

It should be scrapped, he said.


Union delegate Jim Ferguson, a nurse at the Taharoto acute unit near North Shore Hospital, said some at-risk patients who would otherwise need seclusion were nursed one-to-one. But others, particularly those high on P, would need three or four staff.

He favoured scrapping seclusion, but that would be impossible without more staff in a sector that was already short-staffed.

Dr Nick Argyle, clinical leader of mental health services at the Auckland District Health Board, said use of seclusion had reduced since its new acute unit, Te Whetu Tawera, opened last year with its much-increased floor area and other improvements.

Psycho-social therapies, sometimes with medication, were being attempted first on highly agitated patients.


USE OF SECLUSION

* 37 per cent of mental health patients under compulsory assessment and treatment were put in a locked seclusion room for some of their hospital stay.

* The average time in seclusion was 50 hours a month.

* The least time was one hour a month.

* The most was 600 hours - the equivalent of 25 days.

* Most periods of seclusion last eight to 24 hours.

Source: 2000/01 survey of all district health boards