Solitary confinement for acutely ill 'needs to stop'

CRAIG SIMCOX/ The Dominion Post

"OF NO BENEFIT": Former mental health patient Wendy Randall has spoken out against seclusion.

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Psychiatric services should stop using "seclusion" – solitary confinement in a bare room – to manage acutely ill people, a consumer advocate says.

The Health Ministry's annual mental health services report for last year, made public yesterday, shows big differences in seclusion rates nationally.

Director of mental health services David Chaplow cautioned against reading too much into regional differences "as these could be due to a number of variables, including practice, size, location, population and configuration".

However, the report identified lack of appropriate facilities, staff numbers, experience and training and use of sedative drugs as the main factors behind regional differences.

Advocate Anne Helm, who experienced seclusion herself as an inpatient at Lake Alice Psychiatric Hospital in the 1970s, said it was a terrifying experience for "already very distressed" people.

She remembers nurses kicking plates of food into rooms where patients lay on cold linoleum, paralysed by antipsychotic medication, and cells empty of furniture except for buckets that served as toilets.

"In those days they used to do it as punishment, to tell you who was boss ... we've come a long way and there are genuine moves by health boards to reduce the use of seclusion," Ms Helm said. "But we want total abolition."

Nationally, 16 per cent of adult inpatients (not including forensic services) experienced seclusion at least once last year, while 65 children and young people were secluded a total of 200 times.

Canterbury had the highest rate of seclusion "events" – 340 per 100,000 people – about 10 times the lowest reported rate, at Wellington's Capital and Coast.

Maori were more than twice as likely to be secluded and were locked up at nearly three times the rate.

Ms Helm said alternatives could include "time-out" for patients in a supportive environment and peer support workers offering one-on-one care.

'I'd come out angrier  than when I went in'

Wellington woman Wendy Randall who has almost 40 years' experience of mental health services, has "never seen seclusion do anyone any good".

"It's scary," says the 59-year-old, who was diagnosed with post-traumatic stress disorder after an abusive childhood. "I would come out angrier than when I went in."

In the 1970s she was admitted to Cherry Farm in Otago, where seclusion was used as punishment.

"They would remove all your clothes, supposedly so you couldn't hurt yourself, but it was really about power and coercing you into compliance. There was no privacy, no dignity."

Last secluded about 10 years ago in Nelson after trying to leave the unit "in a disassociated state," she "came to about three days later in a locked room. I rang the bell, but no one came for ages ...

"We were there because we were unwell, but treated as though we had done something wrong."

MENTAL HEALTH OVERVIEW

The annual mental health services report shows there were:

* 3921 compulsory treatment orders.

* 6424 patients admitted to inpatient units (excluding forensic and rehab).

* 1395 patients "secluded" for between 2 minutes and 365 days.

* 203 people given electroconvulsive therapy in the year ending June 2008, of whom nearly one in five were treated without their informed consent.

Deaths: 71 people died in 2008 while under compulsory care orders, including 13 reported suicides. 20 deaths still under investigation.

- © Fairfax NZ News