A scathing report into the use of seclusion and restraints in NSW hospitals has compared mental health units to prisons and described a system plagued with discriminatory and stigmatising attitudes.
The review by chief psychiatrist, Dr Murray Wright, was commissioned by the State Government earlier this year in the wake of shocking revelations about the death of Miriam Merten in 2014.
Ms Merten died after being locked in a dark room at Lismore Base Hospital for hours and falling over and hitting her head more than 20 times.
Dr Wright’s review found that last financial year patients were placed in seclusion in mental health units in NSW almost 3,700 times.
They were locked away for an average length of 5.5 hours and seclusion rooms were sometimes “unhygienic”, not properly cleaned and lacking in fresh air and access to bathrooms.
Dr Wright said patients and their carers described services that “traumatise and show a lack of compassion and humanity”.
“Many reported feeling dehumanised and stripped of their sense of autonomy, agency, dignity and human rights,” he wrote.
Among the many submissions received, one couple told the review their daughter would never be the same after being restrained and placed in seclusion as a child and adolescent.
“The nightmares and trauma from these experiences continue to affect her every day, both mentally and physically,” they wrote.
The report said patients had reported staff using seclusion and restraints as a “threat of punishment” or a “means of enforcing compliance and obedience”.
“This form of coercive compliance has more in common with custodial correction systems than it does with a therapeutic setting,” the report stated.
The review also said many mental health units had a custodial feel, and “discriminatory and stigmatising behaviour and attitudes were observed at all levels of the workforce”.
Hospitals treating patients like ‘second class citizens’
Cultural problems were also apparent to the review team on their visits to emergency departments.
It said emergency department staff displayed “unprofessional attitudes” to mentally ill patients.
In a written submission, one hospital staff member told the review team mental health patients were treated like “second class citizens” in emergency departments.
“Often the mental health patients are completely ignored by the nursing staff who consider it is security’s job to observe and care for the mental health patients in the ED,” they wrote.
The report concluded that “if this culture is not addressed, any efforts to prevent or reduce seclusion and restraint will have limited success”.
The poor leadership of some hospital management was also targeted.
“The tolerance of leaders for outdated, discriminatory and damaging attitudes and behaviours among staff was a matter of considerable concern,” the review said.
The report fell short of recommending totally banning the practices of seclusion and restraints, but made 19 other recommendations aimed at reducing their use.
They included calls for the introduction of minimum standards and skill requirements for all staff working in mental health.
It also recommended the inpatients’ service have 24-hour supervision from accountable management and that seclusion and restraint data collection and reporting should include emergency departments.
Health Minister Brad Hazzard said the Government would adopt all the recommendations and immediately invest $20 million to help hospital managers improve the therapeutic environment inside acute mental health units.