Mental Health

Seclusion

The seclusion of a person as defined by the Mental Health Act 2014 (MHA 2014), is when a person is confined to a room or an enclosed space that they cannot leave. This is sometimes necessary in circumstances when the health and safety of the person or others are at risk. MMH closely monitors the rate of seclusion relating to an adult inpatient admission. In 2019/20, our seclusion rate was 10/1,000 which was better than the target of <15/1,000.

Restrictive interventions

Similarly, restrictive interventions are at times necessary to maintain the safety of consumers, carers, their families, and staff. MMH is focused on reducing the rate of, and ultimately eliminating, restrictive interventions. In 2019/20 there were 110 mechanical restraint episodes involving 92 adults admitted to a MMH adult inpatient unit. This occurred at a rate of 2.1 episodes per week. The MHA 2014 defines mechanical restraint as the use of devices (including belts, harnesses, manacles and straps) in order to restrict a person’s ability to move around. Every reasonable effort is made to reduce the actual use and duration of any form of restrictive intervention.

During the same period there were 222 physical restraint episodes involving 92 adults admitted to a MMH adult inpatient unit. This occurred at a rate of 4.3 episodes per week. The MHA 2014 defines physical restraint as ‘hands-on’ action taken to prevent a person from moving around and to protect them from harming themselves or others.

MMH is actively working to reduce the number and duration of restrictive interventions. Initiatives include:

• The MMH Reducing Restrictive Interventions (RRI) Committee continues to track and monitor restrictive interventions across the service as well as identify initiatives that may help reduce the number of incidents of restrictive practices.
• The MMH RRI Committee has been expanded to include the MMH Consumer Consultant, and members from the Emergency Department which is often where restrictive interventions take place and is usually the entry point to inpatient units.
• There is targeted education in the clinician-led Working with People who are Distressed and Agitated training package. This package replaces the former Prevention of Violence and Aggression Training (PIVAT). The new training has a consumer-centred focus that is trauma-informed, gender sensitive and embeds Safewards principles to enable staff to de-escalate and support those in distress or experiencing agitation.
• MMH continues to use Safewards principles in inpatient units to decrease potential situations that cause distress to a person that may arise during admission. There are dedicated Safewards champions who embed this practice within the culture of MMH.
• Restrictive interventions data is now provided to the MMH Consumer Advisory Group Voices of Consumer and Carers Alliance Link Committee (VOCCAL) quarterly. This enables MMH to seek expert opinion from people with lived experience of mental health about how to reduce these practices.
• The Acute Crisis Intervention Service (ACIS) will be commencing work on a local quality improvement activity to improve the uptake of Advance Statements across MMH. Advance Statements are written statements that set down your preferences, wishes, beliefs and values regarding your future care. The aim is to provide a guide to anyone who might have to make decisions in your best interest if you have lost the capacity to make decisions or to communicate them. This improvement work will then be scaled across the other service areas of MMH.

Access to MMH during the coronavirus pandemic

The coronavirus pandemic has created many unforeseen challenges for us all, none more so than people living with a mental illness. MMH has responded by tailoring our services to minimise the risk of infection while continuing to meet the needs of the community.

The Emergency Mental Health (EMH) service has increased capacity during the afternoon shift to better respond to demand. The afternoon shift was identified as time of a consistent high demand of people presenting to the Werribee Mercy Hospital Emergency Department.

With advice and guidance from Mercy Health infectious diseases experts, MMH was able to continue admitting consumers to our adult mental health inpatient units. One of our inpatient units was reconfigured to be able to care for people with a confirmed or suspected case of coronavirus.

MMH has a partnership with Wyndham Clinic Private Hospital to access private beds for public patients, which helps manage demand in the catchment. MMH secured fixed-term access to additional beds to assist with the surge in demand for acute inpatient beds during the pandemic.

MMH experienced a noticeable surge in people accessing mental health services in the community, particularly during the second wave of the pandemic in Victoria. In order to continue to provide the best possible care for our consumers, their carers and families, MMH adopted telehealth for our community service. Face-to-face and outreach support was provided when clinically indicated. MMH plans to deliver a fixed-term, expanded hours response to support this increase in demand.

MMH’s perinatal mental health services developed a coronavirus response plan for the management of the Mother Baby Unit (MBU) at Werribee Mercy Hospital, which usually admits six mothers and six babies at a time. The layout of the building did not allow for the MBU to operate safely at full capacity. The MBU instead converted two inpatient beds to ‘virtual beds’. The mother is discharged from the physical bed and returns home, but continues to receive intensive support from the inpatient multidisciplinary treating team via a telehealth service. This ‘virtual bed’ system has enabled the MBU to continue to provide inpatient care to women during the pandemic and to optimise discharge planning via transfer to a virtual bed. The team developed criteria for transfer and the care model is in the process of evaluation. As of November 2020, 15 women had been transferred to a virtual bed.

Providing virtual care

N is a 37-year old mother of two, with a 3½ year old son and a four week old daughter. She lives with her husband and they have been in Australia for four years, originally from overseas. When her baby was two weeks old, N’s mother passed away unexpectedly. As her mother was overseas at the time, N was unable to attend the funeral. She experienced feelings of anxiety and guilt and over the next two weeks her lowered mood worsened and she started having suicidal thoughts. Fearful of her thoughts and scared that she might hurt her baby, N sought help from her GP. A referral to crisis services was initiated, which led to an admission to the Mother Baby Unit at Werribee Mercy Hospital. Over the next two weeks, N’s stay at the Mother Baby Unit focussed on her recovery, understanding grief and loss, anxiety management and medication management. She and her husband were supported with care of their new baby and understanding children’s attachment needs. This was done with one-on-one hands on support and family meetings with the multidisciplinary team.

After two weeks, N’s ability to cope had improved, and although she had not fully recovered and her mental state was still fluctuating, N and her husband had the confidence to return home.

To support N in her recovery at home, she was transferred to a ‘virtual bed’, where her recovery goals could continue to be supported and her mental state monitored closely for any signs of deterioration. This was done by the same team who had cared for N and her family during her stay at the Mother Baby Unit; this was important as the team knew N and her family, and their struggles and strengths.

N received twice daily phone calls from nursing staff, and had telehealth appointments with the psychiatric registrar, psychiatrist, psychologist and Maternal and Child Health Nurse. In addition, N and her husband could call the ward at any time to discuss any concern or health issue from home.

The Mother Baby Unit multidisciplinary team were able to ensure a smooth transition home, where N was able to be with both of her children and her husband. Prior to discharge from the ‘virtual bed’, additional support was arranged for N. This included Family Foundations, an Enhanced Maternal and Child Health Nurse and access to a psychologist.

After discharge, the transition to home can often be stressful. N and her husband found that the additional support provided made it a more positive experience.

About Mercy Mental Health

In 2019-20, MMH delivered 1,529 acute adult inpatient separations (discharges from hospital) and 72 Mother Baby Unit separations. There were 119 discharges from the Prevention and Recovery Care (PARC) Unit and 40 from the Continuing Care Unit (CCU). 70,442 community service contact hours were delivered. The Perinatal Mental Health service provided care to 823 perinatal community cases in Wyndham, and 436 perinatal mental health consultation and liaison cases at Mercy Hospital for Women, plus 2,738 perinatal mental health outpatient attendances.

Care first: Quality Account 2019/20