Greater support for clinical leadership and collaboration are needed if we are to reach a ‘turning point’ in the NSW health system, the Royal Australian and New Zealand College of Psychiatrists (RANZCP) has said in response to the findings of the independent Review of seclusion, restraint and observation of consumers with a mental illness in New South Wales (NSW) health facilities.
‘The RANZCP applauds the Chief Psychiatrist and NSW Minister for Mental Health for having the courage to open up the NSW mental health system, its culture, resources and workforce, to an independent review,’ RANZCP NSW Branch Chair, Dr Gary Galambos said.
‘The RANZCP commends the report’s recommendations and considers the immediate investment of $20 million into the health system, to improve the therapeutic environment inside acute mental health units, a good first step in funding the reforms necessary to provide quality mental health care in our public hospitals. A large investment is clearly required, in particular to improve the availability of senior clinicians throughout mental health services to set the standard for culture, de-escalation practices and management of acute behavioural disturbance that minimises the need to use seclusion or restraint.
‘We particularly support the review’s recommendation that greater clinical leadership in the health system needs to be facilitated, fostered and supported. We look forward to the Health Ministry responding positively to our calls to establish ‘medical staff councils’ throughout all the mental health services of the NSW health districts to help achieve this aim. Our specialists need to have the opportunity to work directly with administrators to build an effective, efficient and accessible mental health system, whilst consulting consumers and carers continuously for advice and guidance throughout the entire process,’ Dr Galambos said.
‘It is vital that mental health care is guided by compassion as much as by evidence-based treatments, and founded on a commitment to ensure that a supportive, caring and non-traumatising environment is provided to all within its care. This especially applies to emergency departments where many people with acute mental health crises first present for care. There is much that can and needs to be done to improve the provision of mental health care in that environment.’
‘There is absolutely no place for stigma or discrimination within the health system – mental disorders need to be considered equivalent to any physical disorder in terms of priority and access to the highest quality specialist care.’
'Let us not forget the dedicated clinical teams and services who strive to provide humane mental health care and who have done much to minimise the use of seclusion and restraint practices, despite the growing numbers of people presenting to services with extreme behavioural disturbance, such as ice-induced psychosis, who are non-responsive to verbal de-escalation approaches. These staff require skilled leadership, support and resources to protect their mental health and prevent compassion fatigue.'
’There has been a considerable reduction in seclusion and restraint over the past five years of targeted initiatives, and increased awareness of the need to always balance the potential traumatic effects of such practices whilst prioritising safety, as we assist thousands of people to get through periods of overwhelming crisis in their lives,’ Dr Galambos notes.
The Review of seclusion, restraint and observation of consumers with a mental illness in NSW health facilities is available online at www.health.nsw.gov.au). For more information on the RANZCP’s position on the use of seclusion and restraint see: 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.