Closing the equity gap as we approach zero seclusion: Successes of the quality improvement project some doubted could be done

Abstract

Objective

Use of seclusion (in particular inequitable use) continues in mental health services in many countries, despite evidence against it and substantial endeavour to reduce or eliminate it. Aotearoa New Zealand’s national quality improvement agency Te Tāhū Hauora Health Quality & Safety Commission has since 2018 led a project to eliminate use of seclusion in mental health inpatient units.

Method

The ‘Zero Seclusion: Safety and dignity for all’ project co-designed a bicultural change package and implemented it nationwide in a formative collaborative with clinical teams, consumers, families, and whānau. Outcome measures included seclusion rates, duration, and average number of episodes, by ethnicity, with a focus on equity.

Results

From a baseline mean of 6.4% of mental health service consumers secluded monthly in the 12 months to September 2019, the mean rate of seclusion reduced to 4.3% by June 2024. The seclusion rate of Māori mental health service consumers fell from 9.9% to 6.0%, and of non-Māori/non-Pacific consumers from 4.0% to 2.3%.

Conclusion

Reduction and elimination of seclusion, especially its inequitable use with indigenous populations, is possible. True co-design, strong leadership, partnership with indigenous populations and those most affected, and an embrace of robust measurement were critical to these good results.