Nurse perceptions of the use of seclusion in mental health inpatient facilities: have attitudes to Māori changed?

Abstract

PurposeThe purpose of this paper is to examine the results of New Zealand initiatives to reduce seclusion rates and report the attitudes of mental health nurses to seclusion, factors involved in seclusion use, and alternatives to seclusion.Design/methodology/approachA questionnaire was circulated to mental health inpatient staff. Data from the Ministry of Health for seclusion numbers and rates for Ma¯ori and non-Ma¯ori were also collected.FindingsThe major barriers to reducing the use of seclusion related to staffing issues, a lack of management and medical support, and physical characteristics of the facility. Data from the Office of the Director of Mental Health annual reports from 2007-2014 clearly show a reduction in the total seclusion events, the number of patients secluded, and the percentage of total patients secluded. However, the percentage of Ma¯ori secluded compared to the total number of patients secluded showed little change from 2007 to 2013.Originality/valueFurther analysis of the nurse’s responses showed that four of the six least-used strategies incorporated Ma¯ori cultural approaches. The authors surmise that an inability to provide culturally sensitive care, either through staffing or education factors, may be implicated in the lack of change in the seclusion rates for Ma¯ori. This may also be pertinent to seclusion rates for indigenous peoples in other countries.