Children’s seclusion ‘adding to harm’
Mental health staff are isolating distressed children, some aged under
12, in locked seclusion rooms at Christchurch’s ageing Princess Margaret Hospital (PMH).
Newly released figures show between 2013 and 2017, 45 patients aged under 18 were secluded 252 times – one for almost five days.
The Human Rights Commission, Children’s Commissioner and youth experts condemn the practice, saying it can cause more harm.
The Canterbury District Health Board’s (CDHB) mental health boss says staff use seclusion with extreme caution and only ‘‘to prevent imminent harm to others when other measures have failed’’.
The figures show seven patients aged under 12 were placed in seclusion 64 times at PMH.
They were in the room anywhere from 12 minutes to 5.1 hours, with the average time just over an hour. One was secluded 19 times, another
24 times.
Teenagers aged 13 to 18 were secluded more, and for longer.
Thirty-eight patients in that age bracket were placed in seclusion 188 times. The times ranged from six minutes to 114.5 hours – almost five days. The average time was 6.1 hours.
The worst year was 2016, when there were 96 seclusion events in the youth ward.
Last year, seclusion was used 29 times.
Child and family psychologist Sarah Whitcombe-Dobbs said it was ‘‘upsetting to think that some of our most vulnerable young people are being put in seclusion environments that are quite scary and the opposite of a therapeutic intervention’’.
Children should never be placed in seclusion, she said.
There were alternative ways to deal with agitated children posing a risk to themselves or others, but they involved ‘‘increased staff resourcing’’ and better facilities.
Seclusion rooms are controversial. The Ministry of Education banned the practice for schools in
2016 and introduced legislation to make it illegal last year. In child, youth and family residences, a young person cannot legally be in secure care for more than a day without court approval.
The Mental Health Act says seclusion should only be used as a last resort to prevent violent behaviour compromising safety, but has no specific provisions for children apart from requiring guardian consent.
Seclusion ‘to prevent harm’
CDHB head of mental health Toni Gutschlag said seclusion could happen with children suffering psychotic disorders and severe depression, which was rare, and more often with children with autistic spectrum disorders, intellectual disability and severe
emotional dysregulation.
Parents were informed immediately and were involved in the treatment planning.
She said seclusion rooms had en-suite bathrooms and built-in furniture to prevent self-harm, large external windows for natural light and an internal window large enough for the patient to see a staff member’s head.
An intercom system allowed patients to talk to staff at all times. One staff member was assigned to the child for the time they were in seclusion to provide reassurance and monitor their behaviour. Every seclusion was ‘‘robustly and formally reviewed’’.
Staff worked hard ‘‘in trying circumstances and in an inadequate building’’, Gutschlag said.
PMH is derelict, quake-damaged and unfit for purpose. The rest of the hospital moved out in 2016. New mental health facilities on the Hillmorton Hospital campus will be built in 3.5 to 4 years.
Children’s Commissioner Judge Andrew Becroft said the PMH seclusion figures raised serious concerns.
In youth prisons, young people placed in secure care could use a whole unit including shower, toilet, kitchen and outdoor area.
‘‘It’s nothing like being locked in a small room.’’
Seclusion should not be used for children and young people as it was potentially traumatising, he said.
He believed the Government’s mental health inquiry should investigate the figures and consider specific regulations for the use of seclusion for children in mental health wards.
Youth Hub Trust chairwoman Sue Bagshaw said she was helping two people in their 20s who were struggling with posttraumatic stress disorder because they were placed in seclusion or ‘‘time-out’’ rooms in youth mental health wards.
One of them, who spoke on condition of anonymity, said she was placed in a ‘‘timeout’’ room at age 15. Two staff were in the room and told her they would put her in a locked room if she did not stop crying, she said..
She was put in time out repeatedly during her stay and felt it was used to discipline rather than keep youth safe. She said she had frequent nightmares and flashbacks and remained terrified she would be taken to a mental health ward again.
Bagshaw believed seclusion was used because of a lack of resources: ‘‘It takes a lot longer to talk a child down from being out of control than putting them in a secure room.’’
Nationally, more than 800 adult mental health patients and 102 people aged under
19 were held in seclusion at some point in
2016 according to the last Director of Mental Health’s Annual Report. The report had no data for children aged under 12.
The Health and Quality Safety Commission (HQSC) wrote to health board bosses last year about ending seclusion by
2020.
Plans have been in place to reduce the practice since 2009. In 2015, the United Nations Committee Against Torture expressed concern at New Zealand’s use of seclusion for punishment and discipline and last year a scathing report funded by the United Nations slammed New Zealand’s use of seclusion.