By Eileen McAtee
Seclusion, forcibly confining or restraining a person in isolation in a room that is barely furnished, in mental health services has been in the media spotlight this week, following publicity about a young man who has been in seclusion 23 hours a day for the past 3 years. See article in the Dominion Post and this interview with his father on National Radio. It is hard to fathom how this situation can have continued for so long, or the degree of trauma he has experienced over that time.
Further coverage of seclusion followed the release of the Annual Report from the Office of the Director of Mental Health which reports, among other things, on rates of seclusion by age , gender and District Health Board *. The report reveals that more than 1000 patients spent a total of 60,000 hours locked in seclusion last year. As far as I can make out the seclusion statistics for Regional Rehabilitation Services, where the young man has been in continuous solitary confinement were not reported. What the report does show is that Māori are twice as likely to be secluded as non Māori. Te Runanga o Kirikiriroa in Waikato suggested this is because some staff have a preconceived idea that Māori patients could be aggressive. The report also revealed seclusion rates at Southern DHB are 3 times the national average.
It seems timely to release the Kites Position paper on the Use of Seclusion in Mental Health Treatment Facilities in New Zealand . In a nutshell we assert that the use of seclusion be eliminated from all psychiatric facilities for the following reasons:
- It is a violation of human rights
- It is traumatising for all involved and especially for the person being secluded. This trauma can have serious negative effects for many years
- It can seriously damage any trust people may have in mental health services and diminish the likelihood they will seek treatment from them in the future.
The bigger picture is that we all have a role to play if the practice of seclusion is to be eliminated . If we, as a society, demand that people are “cared for” to keep us safe, we end up with a risk adverse mental health system , and in some situations extreme inhumanity and cruelty to our fellow citizens .
Mental health services are in a conflicted situation because the attitudes of and beliefs of many in our communities is that people who are mentally ill are dangerous and unpredictable, and need to be cared for within psychiatric facilities away from the public. This forces treatment facilities to become places of containment and social control and not places of compassion and healing.
If we are to eliminate seclusion from mental health services then all of us need to challenge our beliefs about mental distress and be open to alternative ways of supporting people. This paper provides some ideas about alternative ways of thinking and the Like Minds, Like Mine Programme is a positive step in challenging our attitudes.
The video below, Opening Doors developed by Awareness: Canterbury Action on Mental Health and Addictions delivers a powerful message about the impact of seclusion on all those involved.
* Also concerning in the report is the continuing rise in the number of compulsory treatment orders but that will have to be the subject of another blog .