The New South Wales (NSW) Chief Psychiatrists’ statewide review of seclusion and restraint practices in hospital settings should be extended to include workforce, governance and sedation practices in the NSW mental health system, the NSW Branch of the Royal Australian and New Zealand College of Psychiatrists has urged.
‘The NSW branch of the RANZCP supports the planned NSW inquiry into seclusion and restraint, but we believe that the enquiry should also look at the practice of sedating patients with behavioural disturbance who pose a risk to themselves or others,’ RANZCP NSW Branch Chair, Dr Gary Galambos said.
‘You can’t look at seclusion and restraint in a vacuum. The model of care needs to ensure that there is regular medical assessment and oversight with regard to the use of sedation, seclusion and restraint.
‘We need a consistent statewide approach to the management of acute behavioural disturbance. Specific, evidence-based guidelines for psychiatric units would reduce the risk of trauma and adverse outcomes for patients.
‘More people are presenting to hospitals in a disturbed and aggressive manner due to methamphetamines, particularly ice, and this presents additional challenges when considering sedation.
‘The design of emergency departments and triage systems need to ensure we are able to cater humanely and effectively to agitated patients presenting with mental disorders, which may reduce the need for sedation, seclusion and restraint,’ Dr Galambos said.
‘The NSW Branch of the RANZCP advocates for specific guidelines of best practice to be developed, supported by policy and implemented across NSW with appropriate training given to all staff working in these environments.
‘Psychiatrists take the issue of seclusion and restraint extremely seriously because the experience can be disempowering and traumatising for patients. Seclusion and restraint should be measures of last resort, only used by properly trained professional staff, in an environment that is safe for the patient, and using protocols that have been developed to keep patients safe.
Seclusion and restraint should never be used as a punishment or as a substitute for the provision of quality psychiatric care, support and assertive evidence-based treatments,’ Dr Galambos said.
The RANZCP developed a position statement on this issue just over a year ago: Position Statement 61 minimising the use of seclusion and restraint in people with mental illness.
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The Royal Australian and New Zealand College of Psychiatrists is a membership organisation that prepares medical specialists in the field of psychiatry, supports and enhances clinical practice, advocates for people affected by mental illness and advises governments on mental health care. For information about our work, our members or our history, visit www.ranzcp.org.