“Zero seclusion: towards eliminating seclusion by 2020”. An account of the initiatives led by the Health Quality & Safety Commission that aim to eliminate seclusion and restraint in New Zealand

The New Zealand Health Quality Safety Commission (HQSC) is leading a 5-year national programme to improve quality and safety in the Mental Health & Addiction services. This aims to build and embed improvement science capability in the sector, engage sector leadership in quality improvement and develop a quality and safety culture in services.

This presentation describes the establishment of the national programme and the implementation of the first initiative focused on minimising restrictive care, and in particular seclusion.

“Zero seclusion: towards eliminating seclusion by 2020” sets an ambitious goal. Substantial reduction in seclusion occurred nationally over several years from 2009 but progress then plateaued and use has increased over the last few years. There is significant variation in use across the country, and important equity issues for Maori and Pacific people.

The national initiative uses a hybrid methodology of co-design and improvement methodology similar to that of the Institute for Healthcare Improvement Breakthrough Series (Collaborative) and of the Scottish Patient Safety Programme (SPSP) with whom a partnership has been established.

‘No smoking’ policies and increasing community use of of  ‘meth’ and synthetic cannabinoids have been presented by services as major barriers to elimination. Co-design shows some staff believe that seclusion is a necessary last choice option to maintain safety for everyone.

The presentation describes the implementation of the methodology, challenges associated with the implementation and the approach to perceived barriers to elimination.

In conclusion  “Zero seclusion: towards eliminating seclusion by 2020” is the first initiative in a 5-year improvement programme which provides the opportunity to put Quality and Safety at the centre of mental health and addictions service delivery.


TERP focuses on identifying, avoiding and reducing harm across all environments in which the care of people with mental ill health is provided. TERP inforces Australia’s commitment to reduce the use of, and eliminate restrictive practices as a priority for action. Each jurisdiction, in conjunction with the Safety and Quality Partnership Standing Committee and the Commonwealth Government, works towards this vision by holding a series of forums providing an opportunity to learn and grow from local and national initiatives to eliminate restrictive practices and create a dialogue for future care.

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