Zero seclusion: Safety and dignity for all

Seclusion is the practice of placing a mental health consumer in a room from which they cannot exit freely.

In mental health and addiction (MHA) services, people who arrive in an acutely distressed state are sometimes put into seclusion as a last resort. Seclusion is traumatic and harmful for consumers, whānau, visitors and health workers alike.

The elimination of seclusion in mental health has been government policy for over a decade.

Zero seclusion: Safety and dignity for all project

The Zero seclusion: Safety and dignity for all | Aukatia te noho punanga: Noho haumanu, tū rangatira mō te tokomaha project specifically focuses on eliminating seclusion in Aotearoa New Zealand. The project is part of the wider MHA quality improvement programme, funded by district health boards (DHBs).

The zero seclusion project has been underway since early 2019. The Health Quality & Safety Commission’s goal is to continue sector work with DHBs to eliminate seclusion in MHA services.

The project aims to contribute to the goal of zero seclusion by reducing seclusion rates in adult mental health inpatient units (excluding forensics) in participating localities to 5 percent or below by December 2023.

Alternatives to seclusion 

The Commission is supporting DHBs to find other ways to help people in distress, as alternatives to seclusion. This is being done using quality improvement methodology, with different tools being tested.

By using this quality improvement approach, we have learned that effective ways to support people in distress include bringing them into a quiet space, actively listening to their concerns and needs, learning about what happened to them, discovering their triggers and what calms them, offering them food or a drink and involving their whānau early on, and throughout, if the person wishes. Knowing about these approaches means services can support people in distress in positive ways, reducing and eventually eliminating seclusion.

The zero seclusion team is producing cultural and clinical kete to help further support DHBs in this aim, which will be released later this year.

Working collaboratively 

The Commission is working collaboratively with the Ministry of Health, Te Pou and DHB project teams to further reduce, prevent and eliminate seclusion in sustainable, person-centred, safe and evidence-based ways.

Thanks to the work of Te Pou, we have evidence that approaches showing promise include engaging well with the individual and the family and whānau, peer support and sensory modulation, among others.

Find out more about how the Commission and Te Pou collaborate on the Zero seclusion project here.

Further resources

• Zero seclusion: Safety and dignity for all – change package | Aukatia te noho punanga: Noho haumanu, tū rangatira mō te tokomaha – mōkī aroha
  
• Zero seclusion case studies: How DHBs are successfully reducing the use of seclusion
• Consumer experiences of seclusion (videos)  
• Office of the Director of Mental Health and Addiction Services report release highlights the need to eliminate seclusion (news)  

• National decrease in seclusion rates in inpatient mental health units – particularly among Māori and Pacific peoples

• Auckland District Health Board shows zero seclusion is both possible and sustainable