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Young most likely to be held in solitary

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Children and adolescents in public mental health care are more likely to be held in solitary confinement than adults, government figures show.

Children and young people were being held in seclusion – defined as being confined alone in a room or area where free exit was blocked – at the rate of 20.9 per 1000 bed days in public mental health services in 2011-12, according to figures compiled by the Australian Institute of Health and Welfare.

The comparable rate among patients in general mental health services was 11.9 per 1000 bed days.

The nationwide figures, produced for the first time, show that overall progress is being made in reducing the incidence of seclusion, which was one of the mental health care priorities set by the nation’s health ministers last decade.

At a meeting in 2005, the health ministers resolved that there should be less use made of seclusion as part of a plan to reduce harm in mental health.

As one of the core principles guiding the planning and delivery of care, the ministers resolved that “mental health consumers have the right to receive care in the least restrictive environment, and

with the least restrictive or intrusive treatment, that is appropriate to their health needs and their immediate circumstances”.

The figures compiled by the Institute show that, across all public mental health services, progress has been in this aspect of providing safer care.

Rates of solitary confinement have been cut by around a third, down from a rate of 15.6 events per 1000 beds in 2008-09 to 10.6 in 2011-12.

Among those in general mental health care units, the rate fell from 16.7 to 11.9 between 2008-09 and 2011-12, while among older patients it dropped from 5.1 to 1.6, and in forensic units it edged marginally lower from 11.1 to 10.2.

But among children and adolescents, it actually increased, from 19 to 20.9.

A national breakdown of the figures in 2011-12 showed that patients in the Northern Territory were the most likely to be held in seclusion, with a rate per 1000 bed days of 25.7.

At the other end of the scale, the rate in the ACT was just 1.3, followed by Western Australia with 4.7.

In NSW the rate was 9.8, in Victoria 13.3, in Queensland 13.1 and South Australia 10.1.

Associate Professor John Allan, Chair of the Australian Health Ministers’ Advisory Council’s Safety and Quality Partnership Standing Committee, told the Hobart Mercury that seclusion was traditionally used for patients whose behaviour posed a risk of harm to themselves or others, and could have traumatic consequences.

Seclusion does not stop the behaviour, [and] patients feel they have been let down and suffer a loss of confidence,” Associate Professor Allan said.

Acting Tasmanian Chief Psychiatrist Professor Ken Kirby said seclusion was only used in relatively rare circumstances.

“It is usually a last resort, and is preceded by care plans which identify trigger points and the use of de-escalation techniques – an area in which staff receive extensive training,” Professor Kirby told the Hobart Mercury .

Adrian Rollins