Patients with mental illness at Ballarat Health Services are being locked alone in rooms in so-called 'seclusion episodes' at rates three times higher than the state average.
During the three months from January to March 2020, the Grampians Area Mental Health Service, which BHS delivers, recorded a rate of 22.09 seclusion episodes per 1000 bed days compared to the statewide average of 7.34.
It was the second highest rate of seclusion episodes recorded across the state's 35 mental health services, and the rate has been higher than average for several years.
BHS' use of seclusion comes despite the interim report of the Royal Commission into Victoria's Mental Health System describing seclusion and restraint as "profound and dehumanising" and the Mental Health Act saying the practice should only be a last resort.
"What it means is that the hospital is not managing mental health issues in the community and it's using seclusion as a way of dealing with issues that should be about healing, not about holding people," said Victorian Mental Illness Advisory Council chief executive Dr Tricia Szirom.
Seclusion has a negative impact on healing. When you think about people going in to an acute hospital it's because they are desperate and they want to be treated. There's no healing in this practice ... being locked in a room.Dr Tricia Szirom
"Mental health services are supposed to, under the (Mental Health) Act, use seclusion only as a last resort but when services have a rate that high they must be using it earlier on."
Under the act, seclusion or restraint can only be used to prevent imminent and serious harm to the person or another person.
Victoria's chief psychiatrist Dr Neil Coventry describes seclusion as "the sole confinement of a person to a room or any other enclosed space from which it is not within the control of the person confined to leave".
"The principles outlined in the Act specify that people receiving mental health services should be treated in the least restrictive way possible, meaning that seclusion and restraints can be applied only after all reasonable and less restrictive options have been tried or considered and found unsuitable," Dr Coventry wrote in his 2018-2019 annual report.
He said restrictive interventions in mental health services should be reduced and, where possible, eliminated.
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Dr Szirom said seclusion retraumatised people who were already traumatised.
"In the main people who have mental health issues have them as a result of early trauma and in the main they come out of these hospitals like Ballarat more traumatised than when they went in," she said.
The Victorian Government introduced the Safewards program in 2017 to reduce conflict and containment in hospitals and encourage alternative clinical practices.
Speaking to The Age in April last year, BHS director of acute operations Ben Kelly confirmed BHS had introduced Safewards to reduce the incidence of seclusions. The rate had dipped to 5.47 per 1000 bed days in January to March 2019, but has since quadrupled.
Across the state in 2018-19, 52 per cent of seclusion episodes lasted four or fewer hours but there were 817 cases where the seclusion lasted more than 12 hours.
"Seclusion does nothing to heal people; there's nothing therapeutic about it," Dr Szirom said.
Dr Szirom said many of the state's largest hospitals resorted to using seclusion for difficult patients far less often than BHS and other regional mental health services.
Four of the five services who used the tactic most frequently in the first quarter of 2020 were regional mental health providers.
"Seclusion has a negative impact on healing. When you think about people going in to an acute hospital it's because they are desperate and they want to be treated. There's no healing in this practice ... being locked in a room," Dr Szirom said.
Dr Szirom said seclusion was used when situations escalated.
"We are actually running a training program to help people speak to those with a mental health issue in a different way ... to deescalate the situation," she said.
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"We are training peer workers (who volunteer in hospitals), we hope we will be training police and we are going to be training hospital workers to speak to people in a way that can deescalate a situation.
"We know that using peer workers who have had a similar experience of mental illness increases the capacity of hospitals to deal with these situations."
Dr Szirom said BHS was a large health service with a big catchment area and there needed to be some "really sound thinking about a better way of doing this".
"People don't want to go to hospital but there's not a lot of choice. If you are in mental health crisis you go to a local hospital ... that's where you go and you need to know that where you are going is going to be safe."
Ballarat Health Services was contacted twice for comment.
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