Policy Analysis on Aggression, Seclusion and Restraint in Mental Health Facilities in NSW

This policy analysis sheds light on the guidelines to be followed by healthcare professionals to handle the situation of mental health patients effectively and reduce the use of seclusion and restraint. It discusses the formulation of the problem, setting out objectives and goals, identifying decision parameters, priorities, and search for alternatives.

Running head: POLICY ANALYSIS
POLICY ANALYSIS
Name of the student:
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POLICY ANALYSIS
Aggression, seclusion and restraint: Preventing, minimizing and managing disturbed
behavior in mental health facilities in NSW
Introduction:
Mental health patients often go through different types of mood disorders that make
them vulnerable to depression, sadness, violence, aggression, loneliness confusion and many
others. Among these mood disorders, being aggressive is one of the most significant issues
shown by the Healthcare consumers (Dunn, 2015). In such conditions, the mental health
patients can harm themselves as well as the others who are trying to provide them with the
service. Therefore, it becomes extremely important for the Healthcare professionals to be
well educated, knowledgeable and skilful to handle the situation of the patients effectively.
Such aggressions might make them suicidal; harm themselves as well as the nursing
professionals, verbally abusive to the nurses, and many others (Wagennar, 2014). Therefore,
there are many situations where the nursing professionals become confused about the
interventions that need to be taken in order to handle the situation of the patients effectively.
This might be due to lack of education and proper skills to help the patients or confusions of
the professionals about initiatives to be taken at the urgency of the moments (Neto, 2016). In
such situations, it is seen that the professionals take the resort of restraints and Seclusions
which harm the patient's autonomy and dignity, affect them mentally as well as physically. It
also results the professionals to suffer legally (Friedman, 2017). Therefore the policies are
required for helping the professionals learn about the effective guidelines which they can
follow to ensure proper Service Delivery to the patients and thereby reduce the application of
seclusion and restraint to patients. Therefore this policy has been chosen which sheds light on
the guidelines to be followed thereby helping the readers to understand the steps they can
take to help the mental health patients and reduce their applications of seclusion and restraints

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POLICY ANALYSIS
Formulation of the problem:
This policy had provided a scope for the Healthcare professionals to understand the
different interventions and guidelines they should take under different situations to reduce the
level of harms on the patient due to their own aggression and thereby help them to come out
of this difficult phase and live a better quality life. However, the first step of the policy is
understanding the issues on which the policy should be based (Cobb et al., 2016). While
analysing the policy in details, a number of weakness has been observed in the formulation of
the problem for the policy. The policy has been proposed to maintain the safety of the
patients and to help the professionals follow proper guidelines to help the patients but they
have not been able to establish the importance and the depth of the issues that can take place
from the aggression of the patients. They had provided a very small section as risk and
sudden death which might result from the physical and mechanical restraints. However, these
two sections are not enough to establish the importance of following guidelines to mitigate
the issues (Diem et al., 2014). The policy makers have not been able to establish the depth of
the importance of the problems that arise when patients become aggressive. Moreover they
have not provided any statistical details of the different kinds of incidences that have taken
place in the different Health Care units of New South Wales and therefore the only one
statistical data provided does not suffice to provide a background for the entire policy
development. Another important aspect that has been missed is that the policy has only
mentioned about the negative aspects that takes place on the patients when the seclusion and
restraints are not provided properly or cause severe harm to the patients (Vedung, 2017).
However the entire policy did not at all developed any idea about how the Healthcare
professionals are also affected by the tremendous aggressions that take place from the
aggressive mental health consumers. Often researchers are of the opinion that the mental
health consumers become so aggressive that they might cause physical verbal as well as

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POLICY ANALYSIS
mental assaults to the Healthcare professionals who serve them. Moreover, there are many
legal obligations that the healthcare professionals face while they serve the service users
(Berlin & Carlstorm, 2015). This might be due to lack of knowledge or due to an effective
decision making skills are due to loss of control over the situation when the aggression is
taking place. Such legal obligations can result the Healthcare professionals to get involved in
severe issues that affect their professional careers and also harm them mentally. Therefore
these issues should have been discussed in the policy so as to develop the main basis on
which the principles of caring would have been dependent. Depending upon these issues
only, the guidelines should have been developed and this would have provided the reader an
understanding about why the policy is important to be followed by the Healthcare
professionals (Cusack et al., 2016). Therefore the policy did not successfully participated in
formulating the problem although effective guidelines have been provided as interventions
for the issues and this makes the entire policy half-hearted.
Setting out objective and goals:
One important weakness that had been seen in the policy is that the policy is not clear
about its objectives and goals. For better understanding of the readers, the policy makers
should take care that the objectives and goals are present in clear distinctive sections so that
the readers can understand the interventions which are set for the goals (Stacey et al., 2016).
The policy is more focused on developing interventions about how the Healthcare
professionals would be able to provide evidence based care to patients in situations of
aggression and how well they can decide to take interventions or reduce the scopes of
restraints and secretions effectively without harming the autonomy and dignity of the persons
and respecting the wishes and demands of the family members and the patients. However the
policy does not clarify the objectives and goals upon which the policy is developed
(Wildavsky, 2018). Recent researches are of the opinion that better, the goals have smart

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approach, the better will be helpful for the professionals to be sure about their individual
approach and understand their learning needs to meet the care of the patient (Gooding, 2017).
However, no such smart goals and objectives have been found in the policy paper and
therefore the policy seems to have begun in an abrupted approach. However, if one looks
closely into the background section of the policy, one can find out that the policy paper have
only stated that the main focus of this paper would be reducing the use of seclusion and
restraint for ensuring a major practice change initiative for Australian Mental Health
Services. However, this amount of information cannot be considered as a proper objective
and goal as this information is quite broad and would not help in making the professionals
understand what exactly they are aiming for after reading the entire policy (Althaus,
Bridgman & Davis, 2013).
Identify decision parameters.
Resources:
Some amount of information had been discussed about the resources that would be
required for successful implementation of this policy. The financial resources have not been
discussed in in the policy paper but detailed discussion about the actions of different human
resources had been clearly stated and this is one of the strength of the entire policy. The
policy makers have clearly established the different duties that each of the experts has to take
up on their shoulders so that the policy can be implemented successfully (Di Lorenzo et al.,
2014). Detailed description about the actions of chief executives, managers, clinical staff in
mental health facilities, non clinical staff in mental health facilities have been clearly
discussed. Therefore, this would help the professionals to undertake actions that would ensure
successful following of the guidelines and thereby ensuring a therapeutic care for all the
patients without the need of seclusion and restraint. The policy had also clearly stated about

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POLICY ANALYSIS
the target audience who are mainly the multidisciplinary team and non clinical staff who are
involved in the management of aggressive behaviour of the patients and therefore the work
that they need to undertake to ensure safe service to patients can be considered as an
important resource. The policy makers have also talked about a different set of resources that
are required for this policy maintenance is the documentation procedure resources (Gooding,
2017). In order to ensure proper incident reports, Healthcare records, registers, forms and
many other processes, the Healthcare organisation should have to arrange for all these
resources so that proper documentation can take place (Kirmayer & Pedersen, 2014). For all
these, resources are also required and therefore the Healthcare organisations would be
following the Policy to be prepared with the resources stated above (Paulos et al., 2016).
Therefore, from this detailed analysis, it can be easily stated that the policy makers have
successfully discussed about the resources that would be required for successful
implementation of the policy. They have also provided important and enough information on
the human resources as well as the different other resources required for data maintenance
and others. However they have not mentioned any important facts about the financial
resources required by different organisations to implement the policy programs and others.
Therefore, if these financial resources had included in the policy paper, the policy would have
achieved excellence (Kirmayer & Pedersen, 2014).
Timeframe:
The Policy was published in the year 2012 on 26 June and was stated to be reviewed
on 26 June in the year 2014. However, apart from this amount of information regarding the
time, no other information has been provided in the policy paper. Present researchers are of
the opinion that each policy should have objectives and goals that are associated with periods
such as in case of smart objectives. Smart objectives consists of a category call time frames
were the objectives help the professionals to ensure and thereby plan to achieve a particular

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POLICY ANALYSIS
task within a set deadline (Kirmayer & Pedersen, 2014). However, this policy paper is more
of a guideline-based paper and therefore they have not included any time frame within which
the professionals want to achieve the goal and purpose of the paper. The paper does not have
any time frames and therefore this is one of the most important issue which will reduce the
quality of the policy paper.
Priorities:
One of the most important part of the policy is to properly set out priorities by which
the readers can easily understand the main stakeholders as well as the main aspects of the
policy in great details. An interesting part of the Policy was that it has successfully identified
the high risk consumers and thereby had made them their priorities to address the issues in
details and to provide them with special attention and care so that the high risk consumers can
lead better quality lives. The point 4.1.2 shows the high risks consumers that can help the
readers to understand the main categories of people who are more prone to aggression and
poor quality mental health and thereby considered them as the first priority to treat them and
provide a therapeutic care rather than engaging them in seclusions and restraint interventions
(Isobel &n Edwards, 2017). Not only that the appendix 6 had been found to be more detailed
in its approach in making the readers understand the people whom they should set as their
main priority and had named them as special groups of consumers. Moreover, the policy
makers have been very detailed in their approach regarding the important categories that form
the main basis of their discussions. The first group of priority are the intervention priorities
that are set by the policy makers while preventing disturbed behaviour. The second set of
priority interventions are set by the policy makers while minimising their disturbed behaviour
of the health mental health consumers. Not only that, they have also help the readers to

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POLICY ANALYSIS
understand the legal implications that are also one of the priority that the professional should
focus on (Zirkel, 2014). The legal implications are called priorities because by following this
legal implications only, the professionals would be able to avoid any legal obligations and
therefore would be helping themselves to practice is their profession without getting engaged
in any activities that harm their career and affect them mentally. several restrictions on the
use of restraint and seclusion have also been provided in the policy paper and certain
guidelines and principles have also been provided to help the Healthcare professionals to be
able to understand and internalize the principles in their own care to ensure best health of the
patients (Lantta et al., 2016). Therefore, in this way several priorities have been set
throughout the paper which are not only detailed but also help the professionals to make a
clear idea about the care services that they need to provide to the patients to reduce that
aggression and at the same time reduce the necessity to provide seclusions and restraints
(Joseph, 2016). From this discussion, it can be said that the policy makers have correctly set
the priority and have pointed out the important facts that need to be followed and therefore
the policy have achieved success in a way that it is helpful for the target audience to provide
effective care to the patients.
Search for alternatives:
The policy is a very detailed one which is highly informative and would help the
Healthcare professional to practice with skill and efficiency and thereby reduce the use of
restraints and secretion. A wonderful implementation checklist and definitions page has been
provided that help the professionals to develop knowledge about the different important terms
and whether proper implementations are carried on or not. Moreover, principles of restraints
and seclusion have also been mentioned helping the professionals to develop knowledge on
the principles, they need to follow to ensure safe and quality service. The education and
training requirements also would be helping the organisation to undertake proper changes in

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POLICY ANALYSIS
the organisation ensuring effective education and training for the professionals. Moreover, six
core principles for seclusion and restraints reduction have been discussed (Isobel &n
Edwards, 2017). Those 6 categories were not only detailed but are enough to ensure that the
professionals are maintaining the best practice to reduce aggression of the health care patients
and ensured best quality lives. the different interventions which were discussed in the six
categories are detailed and would help any of the professionals to develop themselves as
expert professionals for the future (Zirkel, 2014). However, there were two important points
that need to be included in the policy paper for betterment. The first important aspect is to
include proper objectives and goals so that the professionals are aware what they are trying to
achieve and thereby set time frames for their own diagnosis of their skills skills and effective
self reflection to know whether they have achieved their goals or not (Lantta et al., 2016).
Secondly, the recovery oriented principles of Mental Health care should be included in with
further details in this paper to align the recovery-oriented approaches with the interventions
mentioned in this paper and thereby help in a comprehensive care method for the mental
Healthcare professionals.
Conclusion:
The policy paper is based on a very important problem that is faced by Mental Health
Care Centers all over the nation. Most of the cases, It is seen that the aggression shown by the
mental health patients result in harming themselves as well as the Healthcare professionals
providing them with service. Therefore the Healthcare professionals tried to undertake
seclusions or restraint interventions to make the patients come under control. However this in
turn has negative aspects and therefore it harms the patients mentally and physically and also
affects the lives of the professionals legally. Therefore the policy has set priorities about how
the healthcare professional should be developing their interventions, skills and knowledge to
ensure the reduction of use of seclusion and restraint and enable therapeutic care to make the

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POLICY ANALYSIS
patients included in the treatment and develop their quality lives. However the policy has
failed miserably in formulating the policy issues properly with very few information been
provided in the background and the purpose section. Therefore although the policy has given
good evidence based practices and intervention, it has not been able to establish the problems
and the different harmful effects that it might have on the patients and the nurses. Although
they have mentioned about the risk, detailed discussion and statistical data about the
prevalence of such occurrences in the nation have also not been provided. In such a
condition, it has failed to meet the benchmark said by the WHO for policy development.
moreover they have also failed to establish objectives and goals and thereby they have made
it difficult for the readers to understand what they actually try to achieve through the
interventions. Another important aspect that should have been included is the admixture of
the approach of recovery oriented Mental Health Care as well as that way the interventions
for reduction of seclusion and restraint and enhancing safe practice. There are 6 important
principles of recovery mediated Healthcare and therefore the policy makers should try to
incorporate them in the policy for better results. Effective time frame should be introduced in
order to ensure that the goals are achieved within the stated deadlines.

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POLICY ANALYSIS
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