Following the ‘Review of seclusion, restraint and observation of consumers with a mental illness in NSW
Health facilities’, we will implement the following recommendations:
|3. The Director of Mental Health should be
a member of the district or network
senior executive and report to the Chief
||Review senior executive structures to include Directors of Mental Health as
members of the senior executive and report to Chief Executive.|
|4. District and network clinical governance
processes should include emergency
department and mental health seclusion
and restraint performance together
||Review existing seclusion and restraint clinical governance processes to
include accountability for both emergency departments and mental health
|5. All mental health inpatient services must
have 24-hour, everyday on-site
supervision from accountable
management representatives. This
supervision must include in-person
rounding on every shift
||Review afterhours management practices to ensure all mental health
inpatient services have 24/7 on-site supervision from accountable
managerial staff, including in-person supervision visits to units on
|6. NSW Health should have a single,
simplified, principles-based policy that
works towards the elimination of
seclusion and restraint
||Develop a single, culturally appropriate NSW Health policy that aims to
eliminate seclusion and restraint, and that recognises human rights and
trauma-informed care principles.|
|7. There should be an immediate
reinvigoration of the implementation of
the NSW Health Smoke-free Health Care
Policy (PD2015_003), which includes
increasing the knowledge and use of
nicotine replacement therapy
||Use the new Smoking Cessation Framework for NSW Health Services
to improve interventions with consumers.|
How can I be involved?
Every local health district and specialty health network will invite patients, carers and their families to be
included in designing their prevention action plans. To find out more, contact your local health district.
What is clinical governance?
Clinical governance helps sustain and improve high standards of patient care. It includes methods to monitor
the standard of care that health services provide. This requires clear communication and strong partnerships
between the executive team, managers and other staff in health services. Reliable clinical governance
processes are essential for patient safety, including the prevention of seclusion and restraint.
Why do Directors of Mental Health need to report to Chief Executives?
In most organisations, critical decisions are made in executive forums. Mental Health Directors need close
working relationships with Chief Executives and other directors in their health service. Health services need
strong, visible and engaged mental health leadership at the highest level to drive through ambitious
Why does NSW Health need a single policy that works towards the elimination of seclusion and restraint?
NSW Health has a number of policies and guidelines that refer to the use of seclusion and restraint. Complex
policy requirements can be confusing and limit quality improvement. The Review of seclusion, restraint and
observation of consumers with a mental illness in NSW Health facilities recommended simplifying with a
single principles-based policy. A simpler, principles-based statewide policy will make it easier for local health
districts and specialty networks and guide quality improvement.
What does the NSW Health Smoke-free Health Care Policy have to do with seclusion and restraint?
The review team heard that the smoke-free health care policy had contributed to consumer aggression
which then led to episodes of seclusion and restraint. International research evidence has found the opposite
effect. Introduction of a smoke-free policy, supported with a range of nicotine replacement therapies, has
helped reduce physical assaults in several psychiatric hospitals. Based on this evidence, the review
recommended better support for implementation of the policy and nicotine replacement therapy.