Mental health patients are still being locked in small sparse seclusion rooms despite district health boards being told to end the practice by the end of the year.
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Some mental health units were finding simple interventions like a cup of tea and some food were helping to drastically reduce the use of seclusion.
The Health Quality and Safety Commission set a goal for DHBs to end seclusion by 2020.
But that has not happened.
Commission chief executive Janice Wilson said some DHBs had even increased the use of seclusion.
Some had told the commission they were "challenged" by outdated facilities that were no longer fit for purpose, she said in a statement.
Other difficulties included not having enough hospital beds, shortages of mental health nurses, patients on methamphetamine and difficulty changing workplace culture.
Though DHBs had missed the mark this year, Wilson said the goal was still attainable and had always been aspirational.
Some DHBs had greatly reduced the use of seclusion, and others were going "considerable periods" without it, she said.
The small West Coast DHB went 174 days without using seclusion this year.
In 2018 and 2019, it had 17 instances of seclusion. This year there had been seven.
Its Manaakitanga Inpatient Unit clinical nurse manager Paula Mason said seclusion had mostly been used if people were aggressive or psychotic and were likely to harm themselves or others.
But her team had found simple interventions like having a calmer place to enter the unit from had helped reduce the need for it.
They found offering food and a hot or cold drink often had a big effect.
Patients may have been so unwell they had not been eating, sleeping or taking care of themselves, she said.
"Bringing home some home comforts of a warm drink and some food, it can break down the barriers," she said.
The DHB was also trying to plan ahead, such as asking seclusion patients what would work better for them if they needed to come to the unit again.
They used bean bags and weighted furniture to make rooms comfortable but still safe, she said.
Frontline workers from other DHBs told the commission they had also noticed the impact of food.
"If you offer kind care to a distressed person, they soften. If you combine that with lots of food, sensory interventionism, weighted blankets, lavender oil spray, you'll be much more successful," an Auckland DHB nurse told the report.
The Auckland DHB began a shift from heavy reliance on seclusion rooms 10 years ago and had gone from 3000 seclusion hours a year to 300 in that time, the report said.
Mental Health Foundation chief executive Shaun Robinson said he supported an end to the traumatic practice.
Change had been hindered by years of government under-investment in mental health, meaning many DHBs struggled to get specialist staff or the right facilities.
The Health Quality and Safety Commission's report said there had been anxiety and fear from some staff about moving away from seclusion, although others had been unfazed.
Mason said some mental health nurses left their profession because of the trauma of being attacked by patients.
Improving the system might keep more of them working and make it safe for everyone, she said.
The commission did not detail the progress of individual DHBs.
