Patients secluded for more than 20 hours in mental health units

He said NSW Health representatives had been meeting with management at hospitals with high seclusion times and devising strategies to minimise its use.

But sometimes he said de-escalation strategies don’t work, or patients become manic or psychotic and aggressive with little warning.

“The point of seclusion is that it’s a safe place,” Dr Bowden said of the locked plain rooms with low lighting, a mattress and soft walls with no ligature points. Staff monitor a secluded patient regularly, usually via a window on the door.

The majority of inpatients in NSW mental health units are never secluded. Only 3.5 per cent of the 11,249 mental health unit admissions involved at least one “seclusion episode” in January to March this year.

“But any is too many from our perspective, and we’re working to reduce that and completely eliminate wherever possible,” he said.

Dr Bowden said COVID-19 restrictions that separated patients from family and the outside world had exacerbated the anxieties of vulnerable patients and made it more difficult for them to contain risky or aggressive behaviour.


A spokeswoman for Cumberland Hospital also said COVID-19 restrictions contributed to the frequency and duration of seclusion episodes. Among the secluded patients were COVID-positive people.

Sydney Local Health District, which oversees Concord Hospital and Royal Prince Alfred Hospital’s mental health unit, said they had a lower threshold for using seclusion rooms to isolate non-compliant patients with COVID-19 if their behaviour placed staff or other patients at risk of infection.

A number of the seclusions at Liverpool hospital were also people who had COVID-19, a spokeswoman for South Western Sydney Local Health District said.

Dr Michael Hazelton, conjoint professor of mental health nursing at the University of Newcastle, said the Omicron wave had put enormous pressure on a mental health system that had not bounced back after Delta.


Staff shortages meant that sometimes gaps were filled by nurses from other wards who were not well versed in de-escalation strategies developed with individual patients and their families, Hazelton said.

“Virtually no nurses go into mental health having anything other than absolutely the best intentions for the people they work with,” he said. “But many nurses working in these services are very likely to have no formal qualification in mental health,” he said.

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