• Print
  • Downloads

    Restrictive practices section (345KB)
    PDF (345KB)

    Restrictive practices tables (518KB XLS)
    Tables (518KB XLS)

    Background

    People with mental illness and their carers advocate that restrictive practices (involuntary treatment, seclusion and restraint) do not benefit the patient and that these interventions either always or often infringe on human rights and compromise the therapeutic relationship between the patient and the clinician (Melbourne Social Equity Institute 2014). The Royal Australian and New Zealand College of Psychiatrists acknowledged this point of view in their recently updated position statement Minimising the use of seclusion and restraint in people with mental illness (RANZCP 2016), balancing the negative aspects of seclusion and restraint against the need for interventions under certain circumstances. The Australian National Mental Health Commission's (NMHC) Position statement on seclusion and restraint in mental health (NMHC 2015) calls for leadership across a range of priorities including "national monitoring and reporting on seclusion and restraint across jurisdictions and services."

    Reducing and, where possible, eliminating the use of seclusion is a policy priority in Australian mental health care and has been supported by changes to legislation, policy and clinical practice. Reduction efforts have been supported by the Australian Health Ministers' Advisory Council, through its key mental health committees, the Safety and Quality Partnership (SQPSC) and Mental Health Information Strategy Standing Committees (MHISSC). The SQPSC's National Mental Health Seclusion and Restraint ('Beacon') project implemented best practice initiatives in 11 services, demonstrating substantial reductions in the use of seclusion and restraint. Eleven national forums have subsequently been held, the most recent in May 2017, to share results and support broader change efforts to shift restrictive practice out of mental health units entirely.

    Since 2008-09, the Safety and Quality Partnership Standing Committee (SQPSC), operating under the auspices of the Council of Australian Government's Health Council, has successfully negotiated the ongoing collection and publication by the AIHW of national seclusion events occurring in Australian specialised mental health acute public hospital services. Data on the use of mechanical and physical restraint was included in the collection in 2013-14 and was reported for the first time in May 2017. Public reporting enables services to review their individual results against state/territory, national rates and like services, thereby supporting service reform and quality improvement agendas. The national data demonstrates a substantial reduction in the use of seclusion within specialised acute public hospital mental health services over the last five years. While still too early to show a trend, it is anticipated that a similar reduction in restraint will be seen over time.


    Key points

    • Almost half (48.2%) of all mental health-related hospital admissions with specialised psychiatric care involved patients with an involuntary mental health legal status, compared with 19.4% of residential mental health care episodes and 13.5% of community mental health care contacts in 2015–16.
    • Nationally, seclusion rates have fallen from 10.6 events per 1,000 bed days in 2011–12 to 8.1 in 2015–16.
    • The average duration per seclusion event was 5.3 hours in 2015–16.
    • Nationally, there were 9.2 Physical restraint events per 1,000 bed days and 1.7 Mechanical restraint events per 1,000 bed days in 2015–16.

    Data in this section were last updated in October 2017.


    Involuntary mental health care

    States and territories have individual legislation on the treatment of people with mental illness; all have provisions relating to the treatment of people in an involuntary capacity. This means that, under some specific circumstances, treatment for mental illness, including medication and therapeutic interventions, can be provided under a treatment order without the individual's consent, either in hospital, residential care or in the community.

    Each state and territories mental health act and associated regulations provide the legislative cover that safeguards the rights and governs the treatment of patients with mental illness receiving care. Legislation varies between state and territories but all contain provisions for the assessment, admission and treatment of patients on an involuntary basis, defined as 'persons who are detained in hospital or compulsorily treated in the community under mental health legislation for the purpose of assessment or provision of appropriate treatment or care'.

    By setting, the highest proportion of involuntary treatment in specialised mental health units was in admitted  units, where nearly half (48.2%) of all public hospital overnight mental health-related separations with specialised psychiatric care were involuntary at some stage during their separation. Note that patients may not remain involuntary for the full period of their admission to hospital, however the separation is coded as involuntary if the patient has received involuntary treatment at any time during the admission. Around 1 in 5 residential mental health care episodes (19.4%) and community mental health care service contacts (13.5%) were involuntary in 2015–16 (Figure RP.1).

    Figure RP.1: Mental health care, by setting and mental health legal status (per cent), 2015-16

    Stacked bar chart showing the proportion of care by mental health legal status in three service settings in 2015–16. Proportion of mental health separations in public hospital services; 44.8% involuntary, 55.2% voluntary. Proportion of episodes of care in residential mental health care services; 19.1% involuntary, 80.9% voluntary. Proportion of mental health care service contacts provided by community mental health care services; 12.5% involuntary, 87.5% voluntary. Refer to table RP.1.

    Sources: National Hospital Morbidity Database, National Residential Mental Health Care Database, National Community Mental Health Care Database.

    Source data: Restrictive practices Table RP.1 (518KB XLS).


    References

     

    Melbourne Social Equity Institute (2014) Seclusion and Restraint Project: Overview. Melbourne: University of Melbourne.

    National Mental Health Commission (NMHC) 2015. Position Statement on seclusion and restraint in mental health. Sydney: NMHC.

    Royal Australian and New Zealand College of Psychiatrists (RANZCP) 2016 Position Statement 61: Minimising the use of seclusion and restraint in people with mental illness, Melbourne: RANZCP.

    Senate Community Affairs References Committee (2016). Viewed July 2017

    | Seclusion >