Ms Monica de Nooyer1
1Queensland Health, Wacol, Australia
Biography:
Monica is an endorsed Clinical Psychologist and AHPRA board approved supervisor who is the Advanced Psychologist & Therapies Lead in the Forensic & Secure Inpatient Services at The Park-Centre for Mental Health. Monica has over 12 years’ experience working with forensic mental health consumers. Monica oversees the therapeutic group program, provides education to staff and students, and maintains a case load of patients in the High-Security Inpatient Service. Monica is the clinical lead of the Seclusion and Restraint Reduction Program. Monica’s focus is on providing least restrictive, recovery orientated and trauma-informed care to consumers who require management of challenging behaviours.
Abstract:
The seclusion of patients in Queensland’s Authorised Mental Health Services is to be used as a last resort. Within the High Security Inpatient Service four patients have required protracted seclusion. Their illness is characterised by an anxiety response and consequential safety behaviours of avoidance/escape (“flight”) or defence (“fight”) when faced with release from seclusion which can result in physical harm to the patient, co-patient, and staff. Seclusion is thus necessitated to ensure safety, perpetuating the cycle of anxiety and protracted seclusion.
This project aimed to reduce use of seclusion and mechanical restraint through implementation of a Cognitive Behavioural Therapy (graded exposure) intervention informed by individual case formulation.
Following the action cycle of the Knowledge to Action Framework an implementation protocol was prepared. The Mental Health Alcohol and Other Drugs Branch temporarily funded the formation of an Individual Support Team of multi-disciplinary clinicians to implement this intervention. The design is a series of single-n, A (baseline)-B (post-intervention) design studies. The dependent measures are time out of seclusion, use of mechanical restraint, and RiskMan incidents.
Rigorous evaluation of the intervention demonstrated a diminished flight/fight response occurred through the process of habituation. Time out of seclusion increased, use of restraint decreased to the point of cessation for two (of three) patients, and an overall reduction in RiskMan occurred.
Robust practice-based evidence has resulted; a dedicated team can effectively implement a graded exposure intervention to safely reduce use of seclusion and restraint for consumers subject to protracted seclusion in high secure mental health facilities.