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    Admitted patient care Tables AD.16 & 17 (1MB XLS)
    Tables (1MB XLS)

    Seclusion

    Seclusion is defined as the confinement of a patient at any time of the day or night alone in a room or area from which free exit is prevented. The purpose, duration, structure of the area and awareness of the patient are not relevant in determining what is or is not seclusion.

    Seclusion also applies if the patient agrees to or requests confinement and cannot leave of their own accord. However, if voluntary isolation or 'quiet time' alone is requested and the patient is free to leave at any time then this social isolation or 'time out' is not considered seclusion.

    While seclusion can be used to provide safety and containment at a time when this is considered necessary to protect patients, staff and others, it can also be a source of distress not only for the patient but for support persons, representatives, other patients, staff and visitors. Wherever possible, alternative, less restrictive ways of managing a patient's behaviour should be used, and the use of seclusion minimised.


    Background

    In 2005, Health Ministers endorsed the National safety priorities in mental health: a national plan for reducing harm, Australia’s first national statement about safety improvement in mental health. The plan identified 4 priority areas for national action including ‘reducing use of, and where possible eliminating, restraint and seclusion'.

    In line with the plan, there have been a number of initiatives aimed at reducing seclusion and restraint in public mental health facilities. However, despite these initiatives, there is at present no formal, routine nationally agreed data collection and reporting framework for seclusion and restraint to monitor reform progress. To collect this information, a number of ad hoc seclusion data collections for specialised mental health public acute hospital services have been conducted by the Safety and Quality Partnership Standing Committee (SQPSC), of the Mental Health Drug and Alcohol Principal Committee (MHDAPC), in partnership with the relevant state and territory authorities.

    The Australian Health Ministers Advisory Council (AHMAC) mental health committees are in the process of formalising the ad hoc SQPSC seclusion data collection arrangements within a routine, national collection and reporting framework. The Mental Health Information Strategy Standing Committee (MHISSC) is working with AIHW to develop an aggregate mental health Seclusion and Restraint Data Set Specification (SECREST DSS). The SECREST DSS will standardise the national collection of both seclusion and restraint data (and provide a more detailed data set) from the 2015–16 collection period.

    National seclusion data were first collected in 2008–09 with these data published for the first time in 2013. A number of enhancements have been made to the collection, and for the first time in 2014 additional data such as seclusion duration and target population are reported in this section.


    Overview

    Nationally, there were 8.0 seclusion events per 1,000 bed days in 2013–14. The national rate of seclusion has gradually decreased over time. In 2009–10 there were 13.5 seclusion events per 1,000 bed days and the rate of seclusion has steadily decreased over the last 5 years to 8.0 in 2013–14 (Figure AD.10). This represents an average annual reduction of 12.2% over the 5 year period.


    Figure AD.10: Rate of seclusion events, public sector acute mental health hospital services, 2009–10 to 2013–14

    Vertical bar chart showing that the national rate of seclusion events per 1,000 bed days has steadily decreased over the 5 years from 2009–10 to 2013–14. The highest rate was in 2009–10 (13.5), followed by 2010–11 (11.8), 2011–12 (10.4), 2012–13 (9.6) and 2013–14 (8.0). Refer to Table AD.16

    Source: State and territory governments, unpublished.
    Source data Admitted patient mental health-related care Table AD.16 (1MB XLS).


    States and territories

    Over time

    In 2013–14, the Northern Territory had the highest rate of seclusion with 21.6 seclusion events per 1,000 bed days and the Australian Capital Territory had the lowest (1.1). Overall, seclusion rates have fallen for 7 of the 8 jurisdictions between 2009–10 and 2013–14 (Figure AD.11). Western Australia (-18.8%) reported the greatest annual average reduction in seclusion rates over the 5 year period, followed by Victoria (-17.2%). Tasmania (7.2%) was the only jurisdiction to report an increased seclusion rate since 2009–10, however, the 2012–13 and 2013–14 figures were impacted by a small number of clients having a greater than average number of seclusion events. Data for smaller jurisdictions should be interpreted with caution as small changes in the number of seclusion events can have marked impact on the overall jurisdictional rate. Further jurisdictional-specific information about seclusion data is available in the accompanying data quality statement.


    Figure AD.11: Rate of seclusion events, public sector acute mental health hospital services, states and territories, 2009–10 to 2013–14

    Clustered bar chart showing the seclusion rate per 1,000 bed days for all jurisdictions over the 5 years from 2009–10 to 2013–14. The majority of jurisdictions show a decreasing rate of seclusion events from 2009–10 to 2013–14; NSW (11.5 to 7.4), Vic (19.4 to 9.2), Qld (15.0 to 11.1), WA (11.6 to 5.0), SA (7.6 to 4.5), ACT (1.7 to 1.1) and NT (23.0 to 21.6). Tas shows an increase in the rate of seclusion events per 1,000 bed days (11.5 to 15.2). Refer to Table AD.16

    Note: The increase in the state-wide Tasmanian seclusion rate for 2012–13 and 2013–14 data is due to a small number of clients having an above average number of seclusion events. Victoria has fewer beds per capita than other jurisdictions, and as such, it may be useful to view the rate of seclusion events in a broader population context (rates per capita). Due to the low ratio of beds per person in the NT compared with other jurisdictions, the apparent rate of seclusion is inflated when reporting seclusion per patient day compared with reporting on a population basis. Due to the low number of beds in the Northern Territory, high rates of seclusion for a few individuals has a disproportional effect on the rate of seclusion reported

    Source: State and territory governments, unpublished.
    Source data Admitted patient mental health-related care Table AD.16 (1MB XLS).


    Frequency and duration

    About 1 in 20 (5.3%) mental health-related admitted patient care episodes in Australian public hospitals reported a seclusion event in 2013-14. The Northern Territory had the highest proportion of episodes with a seclusion event (7.6%), while South Australia had the lowest (3.9%). Nationally, of those patients who had been secluded, the average number of seclusion events was 2.1 per admitted care episode. The Australian Capital Territory was unable to provide the number of admitted patient care episodes and as such is excluded from this national proportion of seclusion events per episode.

    In 2013–14, the average duration of a seclusion event was 6.0 hours. This national average includes events in general, child and adolescent and older person units only. Forensic services, services provided primarily for people whose health condition has led them to commit, or be suspected of, a ciminal offence or make it likely that they will reoffend without adequate treatment or containment, are not included in this average, as forensic seclusion events are typically of longer duration, and substantially skew the overall average.

    Victoria reported the longest average seclusion duration with an average of 9.5 hours per seclusion event. The Australian Capital Territory had the shortest, with 2.1 hours (Figure AD.12). South Australia captures duration in 4 hour blocks. Due to this differing methodology, South Australia is not included in the national average duration.


    Figure AD.12: Average number of hours in seclusion per seclusion event, public sector acute mental health hospital services (excluding forensic events), by state or territory, 2013–14

    Vertical bar chart showing the average number of hours spent in seclusion per seclusion event in 2013–14.  Victoria had the highest average number of hours reported (9.5), followed by the Northern Territory (6.4), New South Wales (6.0), Tasmania (4.1), Queensland (3.8), Western Australia (2.5) and the Australian Capital Territory (2.1). The average seclusion duration could not be calculated for South Australia due to differences in reporting methodology. Refer to Table AD.18.

    Note: Due to longer duration times in forensic settings, these events have been excluded from this analysis. South Australia report seclusion duration in 4 hour blocks. Therefore, the average seclusion duration cannot be calculated for this figure. Queensland and the Northern Territory do not report any acute forensic services, however forensic patients can and do access acute care through general units.

    Source: State and territory governments, unpublished.
    Source data Admitted patient mental health-related care Table AD.18 (1MB XLS).


    Target population

    Seclusion data can also be presented by the target population of the acute specialised mental health hospital service where the seclusion event occurred. However, data should be interpreted with caution as this methodology uses the target population of the service unit, not the target population of the patient.


    Over time

    In 2013–14, the highest rate of seclusion was for child and adolescent and general services with 9.6 and 9.5 seclusion events per 1,000 bed days, respectively. Older person services had the lowest rate of seclusion events (0.5). Overall, there has been a decrease in seclusion events across all target populations between 2009–10 and 2013–14. Seclusion rates in older person services (-34.4%) had the greatest average annual reduction in seclusion rates over the 5 year period, followed by general services (- 11.3%). Although a reduction in seclusion rates was observed for forensic and child and adolescent services (-6.4% and -4.3% respectively), some variability is apparent from yar to year (Figure AD.13).


    Figure AD.13: Rate of seclusion events, public sector acute mental health hospital services, by target population, 2009–10 to 2013–14

    Clustered bar chart showing the rate of seclusion events per 1,000 bed days for all target populations over the 5 years from 2009–10 to 2013–14. All target populations show a decreasing rate of seclusion events from 2009–10 to 2013–14; General (15.4 to 9.5), Child and adolescent (11.4 to 9.6), Older person (2.9 to 0.5), Forensic (6.9 to 5.3). The mixed category was no longer reported in 2013–14.  Refer to Table AD.17

    Note: In 2013–14, improvements were made to the reporting of target population categories. The mixed category is no longer reported as all seclusion events can now be disaggregated into other target population categories. Queensland and the Northern Territory do not report any acute forensic services, however forensic patients can and do access acute care through general units.

    Source: State and territory governments, unpublished.
    Source data Admitted patient mental health-related care Table AD.17 (1MB XLS).


    Frequency and duration

    In 2013–14, forensic services reported the highest proportion of seclusion events per episode, with 9.0% of all mental health-related admitted patient care episodes reporting a seclusion event. This was followed by general (5.5%), child and adolescent (3.8%), and older person (1.0%) services.

    Of those patients who had been secluded in a forensic service, the average number of seclusion events was 3.1 per admitted care episode. The average frequency for child and adolescent services seclusion events was slightly lower with 2.5 per admitted care episode, followed by general and older person services (2.0 and 1.9 respectively).

    Seclusion events that occurred in forensic services had an average duration of 64.7 hours per seclusion event, which is much greater than all other target population categories. General services reported an average time of 6.3 hours per seclusion event, followed by older person (3.5 hours) and child and adolescent (1.3 hours) services (Figure AD.14).


    Figure AD.14: Average number of hours in seclusion per seclusion event, public sector acute mental health hospital services, by target population, 2013–14

    Vertical bar chart showing the average number of hours in seclusion per seclusion event by target population for 2013–14. Forensic services had the highest average number of hours in seclusion per seclusion event (64.7 hours) followed by General (6.3), older person (3.5) and child and adolescent (1.3). Refer to Table AD.19

    Note: South Australia report seclusion duration in 4 hour blocks. Therefore, average duration seclusion figures do not include South Australia. Queensland and the Northern Territory do not report any acute forensic services, however forensic patients can and do access acute care through general units.

    Source: State and territory governments, unpublished.
    Source data Admitted patient mental health-related care Table AD.19 (1MB XLS)


    Remoteness

    Due to the small number of hospitals located in Outer Regional and Remote areas, for the purpose of remoteness analysis these categories have been combined. There were no hospitals in this dataset located in Very remote areas.

    In 2013–14, hospitals located in Major Cities had a seclusion rate of 7.6 events per 1,000 bed days. This rate was lower than that for Inner Regional facilities (9.7) and Outer Regional and Remote area facilities combined (11.3). The proportion of mental health-related admitted care episodes with a seclusion event was similar across facilities in all areas.

    On average, seclusion events in facilities in Major Cities were longer in duration (6.4 hours) than those in Outer Regional and Remote (6.1) and Inner regional (4.4) areas.



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