Terms of reference

Background

The NSW Mental Health Act (2007) and existing policy require that NSW Health staff undertake all possible measures to prevent and minimise disturbed or aggressive behaviour, and reduce the use of restrictive practices such as seclusion and restraint.

The Act requires that (s68)

• people with a mental illness or mental disorder receive the best possible care and treatment in the least restrictive environment enabling the care and treatment to be effectively given, and that
• any restriction on the liberty of patients and other people with a mental illness or mental disorder and any interference with their rights, dignity and self-respect is to be kept to the minimum necessary in the circumstances.

For the great majority of people with a mental illness or disorder, treatment is most appropriately provided in the community. For those whose problems are more severe and complex, treatment in a hospital inpatient unit may be indicated for a limited period of time. This is more likely where more intensive treatment is required to keep the person and those around them safe.

The existing NSW Health Policy Aggression, Seclusion and Restraint in Mental Health Facilities in NSW emphasises the role of prevention and the use of a range of therapeutic interventions in reducing seclusion and restraint.

Terms of the review

In relation to the seclusion, restraint and observation of mental health consumers in NSW Health facilities and services, this review will:

1. Consider whether existing legislation, policy, clinical governance and oversight, principles and practice standards are consistent with national standards, leading evidence and international best practice principles, and the expectations of consumers and the community
2. Examine the application of existing mental health legislation, policy, clinical governance and oversight, principles and practices, and the extent to which these have been adhered to across NSW Health facilities with acute mental health units, mental health intensive care units and declared emergency departments.
3. Taking into consideration the findings at (1) and (2), make recommendations for amendment to
1. legislation
2. policy
3. reporting
4. clinical governance and oversight
5. practice standards; and
4. Make recommendations for any system capability building required to support clinical and non-clinical staff to implement any proposed legislation, policy or practice changes.

Governance

The Review will be undertaken by an expert panel led by the NSW Chief Psychiatrist.

A review team has been appointed, comprised of:

1. Dr Murray Wright, Chief Psychiatrist
2. Ms Karen Lenihan, Principal Official Visitor
3. Dr Kevin Huckshorn, CEO, Huckshorn and Associates
4. Ms Julie Mooney, Executive Director, Nursing and Midwifery, Southern NSW LHD
5. Dr Robyn Shields, Deputy Commissioner, NSW Mental Health Commission
6. Ms Jackie Crowe, Commissioner, Australian Mental Health Commission (consumer representative)

Dr Wright will report to the Secretary, Ministry of Health.

The Secretary will report on progress and outcomes of the review to the Minister for Mental Health and the Minister for Health. The Secretary will engage with the Mental Health Commission of NSW at key points through the review process.

Methodology

The review will:

• undertake site visits to NSW hospitals with acute mental health units,  mental health intensive care units and declared emergency departments
• undertake a review of a sample of cases which involved the seclusion of a consumer with a mental illness or disorder, to determine the extent to which existing legislation, policy, clinical governance and oversight, and practice standards have been applied
• undertake review and analysis of the existing NSW policies (including revised policy on restrictive practices, and consumer observations, which are currently under review), legislation and practice, and leading evidence and international best practice
• call for written submissions, and undertake thematic analysis
• facilitate face to face consultations with key stakeholders through one-to-one meetings and consultation workshops with key stakeholders, including bodies that are representative of people with a lived experience of mental illness and their families or carers
• make a recommendation on a pathway for the reduction of seclusion and restraint practices in NSW
• provide a final report and recommendations.

Timeframe

The review will report to the Minister for Mental Health and the Minister for Health by Friday 8 December 2017.​​​​​​