Chief Psychiatrist's annual report 2008-09 - Department of Health

32 Chief Psychiatrist’s annual report 2008–09
approach. The project focused initially on the largest inpatient service component — adult acute
inpatient units — and will over time be extended to child and youth and aged persons mental health
services. One of the project objectives is to safely reduce and, wherever possible, eliminate the use
of restraint and seclusion.
The project had two key elements. The first was the development, implementation and evaluation
of a training and education framework using a prevention and early intervention model. This
commenced in 2007. A training and education program was rolled out across the state, with 585
mental health service staff completing the training. The purpose of the training was to increase
awareness of issues regarding the use of restraint and seclusion and to support practice change
while ensuring that practice complied with legislation and demonstrated adherence to guidelines.
The second component was the establishment of project sites in both rural and metropolitan
locations. Six adult acute inpatient units were selected through an expression of interest process.
These pilot sites were required to identify enablers and barriers to the reduction of seclusion and
restraint and to develop and implement seclusion and restraint reduction plans. The project ran
from January to September 2008 at these sites.
Key findings from the Creating Safety project include:
• reducing seclusion and restraint requires clinical leadership and organisational support
• it requires the involvement of all staff — not just nursing staff
• systems improvement needs to be underpinned by rigorous monitoring and review processes
• the experience of consumers and carers is fundamental to informing and evaluating practice
and should be incorporated systematically
• an appropriate physical environment and a supportive therapeutic milieu are integral strands
of a reduction strategy
• good practice needs to be sustained by a prevention and early intervention approach which
includes training in appropriate practice standards when restraint and seclusion are used
• practice change requires a sustained effort.
The Creating Safety project has demonstrated that the use of restraint and seclusion can be
reduced safely and effectively through the use of multiple strategies, including organisational
and clinical leadership; staff education; enhancing the physical and therapeutic environment;
monitoring and data analysis; active involvement of consumers as partners in care; and
identification of alternatives to restraint and seclusion.
The final report for the Creating Safety project is currently being developed and will include learning
from the project, tools and resources, and a training and education program template. The report
will be published and uploaded to the websites of the Chief Psychiatrist and the Victorian Quality
Council. It aims to provide a platform that public mental health services can use to create their own
restraint and seclusion reduction plans and initiate local practice improvements.
Beacon national demonstration project
Four inpatient units at Thomas Embling Hospital and the acute inpatient unit at Peninsula Health
participated as ‘Beacon’ sites in the national demonstration project for the reduction of restraint
and seclusion. These sites acted as centres of excellence in the reduction of restraint and