It also seems to me that some of the seclusion indicators for which data is
available, for example “seclusion hours per 100k Population”, appear to be of
very limited utility for understanding how and when seclusion is used.
I would note that good data is absolutely essential if any meaningful change
is to be achieved. I would also suggest that transparency is a critical element
for achieving any change. I was concerned about the quality of the data and
responsiveness in our interactions with the Ministry of Health.
Frequency and length of seclusion events
Despite the stated intentions and best efforts of many individuals and bodies,
and funding to facilitate efforts to reduce and eventually eliminate the use
of seclusion in mental health, the overall picture from data and submissions
provided to this review was one of persisting use, disproportionately with Mäori
and Pacific Peoples service users.
Space does not allow detailed examination or discussion of why seclusion and
restraint practices persist despite efforts to limit and eventually eradicate them.
Institutional change is difficult to achieve, and staffing pressures undoubtedly
make change even more difficult.
As noted above, the lack of reliable data made it difficult to assess changes since
the original review, but data from the national KPI dashboard11 demonstrated that
the goal of eliminating the use of seclusion and restraint in health and disability
facilities had not yet been met.
Between 2016/17, when the initial review took place and 2018/19, the average
number of seclusion events per person rose from 2.12 to 2.86 seclusion events
per person (Dashboard data). On a positive note, the average length of seclusion
events slightly reduced, but remained over two days.
10. Seclusion is defined as: ‘Where a person is placed alone in a room or area, at any time and for any duration,
from which they cannot freely exit’. New Zealand Standards. Health and Disability Services (Restraint
Minimisation and Safe Practice) Standards. Ministry of Health. 2008.
Personal restraint is when a service provider(s) uses their own body to limit a service user’s normal freedom
of movement. New Zealand Standards. Health and Disability Services (Restraint Minimisation and Safe
Practice) Standards. Ministry of Health. 2008.
Environmental restraint is where a service provider(s) intentionally restricts a service users’ normal access
to their environment, for example where a service users’ normal access to their environment is intentionally
restricted by locking devices on doors or by having their normal means of independent mobility (such as
wheelchair) denied. Health and Disability Services (Restraint Minimisation and Safe Practice) Standards.
Ministry of Health. 2008.
11. The New Zealand Mental Health and Addictions KPI Programme (KPI Programme)
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