The annual report for 2017 by the Office of the Director of Mental Health Services highlights real concerns regarding the increasing rates of restrictive practice (seclusion, restraint and the Mental Health Act) being used upon Māori by mental health services.
Some mental health professionals may view restrictive practice as the safest and most efficient intervention for an emotionally distressed person. But people under its influence describe it as restrictive and disempowering and that the treatment they receive is more closely aligned with the clinicians’ needs than their own.
There is limited recognition that these interventions are associated with an increased incidence of injury to both service users and staff. These injuries can be both physical and psychological. For some people, the use of control procedures may recapitulate previous traumatic experiences, and exacerbate further emotional problems.
From the perspective of Māori who access mental health services, the use of restrictive practices need to stop being legitimised under the Mental Health Act. Programmes have been available to mental health services to foster strategies to reduce the utilisation rate of these interventions. Which include service-user feedback mechanisms, policies concerning restraint and seclusion minimisation, regular auditing, and other quality controls. There still remains an urgent need to challenge and address restrictive practices as they represent gross human rights violations.
We support the Ministry of Health’s mission to reduce the disparity of Māori mental health outcomes. Publishing data on the rate of Māori subject to restrictive practice is just one aspect of prompting a wider conversation and awareness around Māori over-representation across restrictive practices and in compulsory assessment and treatment under the Mental Health Act.
Through the work of Te Rau Matatini Māori have identified a number of solutions including a holistic approach to service provision, incorporating tīkanga Māori (Māori customs), te reo Māori (Māori language), mātauranga Māori (Māori knowledge) and increased whānau involvement. In addition to the provision of acute mental health care in alternative, less restrictive environments.
Te Huarahi o te kete Pounamu was formed as national body of Māori with lived experience of mental health care to improve advocacy for Māori and to increase representation of Māori service user perspectives in mental health services and to influence policy and decision-making.
It is the mental health sector that need to actively address the issues of restricted care in order to make mental health care for Māori as empowering an experience as possible.
Maria Baker is the chief executive of Te Rau Matatini, the National Centre for Māori Health, Māori Workforce Development and Excellence.