Mental health servicesin Australia
Health Ministers endorsed the National safety priorities in mental health: a national plan for reducing harm (the plan), Australia's first national statement about safety improvement in mental health, in 2005. The plan identified 4 national priority areas for national action including 'reducing use of, and where possible eliminating, restraint and seclusion' (see key concepts for definitions).
In line with the plan, the National Mental Health Seclusion and Restraint Project (2007–2009), known as the Beacon Project, was developed as a collaborative initiative to establish demonstration sites as centres of excellence aimed towards reducing seclusion and restraint in public mental health facilities. Key to this work has been translating international lessons and initiatives to the Australian environment and the development and implementation of policies, guidelines and staff training based on good practice. Project outcomes were positive, with several Beacon sites reporting significant reductions in the use, and/or duration of seclusion, thus providing the foundation for further change.
To maintain the collaborative approach and momentum from the Beacon project, states and territories agreed to host ongoing annual National Mental Health Seclusion and Restraint forums. These forums have provided opportunities to showcase initiatives, report on progress, share lessons with external stakeholders and identify areas for further focus.
More recently, the National Mental Health Commission has formed a multi-disciplinary research team and core reference group of experts to examine best practice in reducing, and where possible eliminating, restraint and seclusion. The project scope is broader than the original Beacon Project, extending scrutiny beyond hospitals to the use of restrictive practices in community, custodial and ambulatory settings. Consultation with people with a lived experience and their families, clinicians and people working in services, are considered key to the national project, especially in determining the extent of restrictive practices.
At present there remains no formal, routine nationally agreed data collection and reporting framework for seclusion and restraint, despite these ongoing initiatives. However, a number of ad hoc seclusion data collections for specialised mental health public acute hospital services have been conducted by the Safety and Quality Partnership Standing Committee (SQPSC), of the Mental Health Drug and Alcohol Principal Committee (MHDAPC), in partnership with the relevant state and territory authorities for presentation at the national forums and are reported here.
Data from the 2012 national forum were publicly released for the first time in June 2013 under special agreement with data custodians. The Australian Health Ministers’ Advisory Council (AHMAC) has since agreed to the annual public release of the ad hoc national and state/territory seclusion data presented at the national forums. Coinciding with the 2013 national forum held in Canberra, the data presented on this website extends the period of available data to 2012–13 and updates historical data. Work is ongoing to investigate jurisdictional capacity to routinely supply seclusion and restraint data in line with agreed national definitions.
Nationally there were 9.6 seclusion events per 1,000 bed days in public acute specialised mental health hospital services in 2012–13 (Figure AD.10). See the Specialised mental health facilities section for further information about these hospital services. The national seclusion rate has fallen since 2008–09, from 15.5 seclusion events per 1,000 bed days in 2008–09 to 9.6 in 2012–13; representing an average annual reduction of 11.3% over the 5 year period.
Source: State and territory governments, unpublished.Source data Admitted patient mental health-related care Table AD.16 (344KB XLS).
Jurisdictional rates ranged from 0.9 seclusion events per 1,000 bed days in the Australian Capital Territory, to 19.7 in Tasmania in 2012–13 (Figure AD.11).
Note: The increase in the state-wide Tasmanian seclusion rate for 2012–13 data is due to a small number of clients having an above average number of seclusion events.
Seclusion rates have fallen for most jurisdictions between 2008–09 and 2012–13 (Figure AD.12). The Australian Capital Territory (-49.1%) reported the greatest annual average reduction in seclusion rates over the 5 year period, followed by Western Australia (-21.0%). Tasmania (6.5%) was the only jurisdiction to report an increased seclusion rate, however, the 2012–13 figure was impacted by a small number of clients having a greater than average number of seclusion events. Data were not available for South Australia and the Northern Territory for the 2008–09 collection period. Data for smaller jurisdictions should be interpreted with caution as small changes in the number of seclusion events can have marked impact on the jurisdictional rate. Further jurisdictional-specific information about seclusion is available in the data source section.
n.a. Not available (blank).
Note:The increase in the state-wide Tasmanian seclusion rate for 2012–13 data is due to a small number of clients having an above average number of seclusion events.
Seclusion data can be presented by the target population of the acute specialised mental health hospital service where the seclusion event occurred. Nationally, child and adolescent units had a higher rate of seclusion events (14.5 per 1,000 bed days) compared with general units (10.3) in 2012–13 (Figure AD.13). However, it is important to note that many child and adolescent services are included in the mixed category, which can refer to any combination of older person, forensic, general, youth and child and adolescent services. Work is currently underway to improve the data collection methodology to enable these services to be separately identified, removing the mixed category, thus improving data for the various target population categories.
There was a decline in seclusion rates across almost all target population categories between 2008–09 and 2012–13. General (-11.8%) and mixed (-9.8%) services had similar average annual reductions in seclusion rates over the 5 year period. Seclusion rates in older person services (-33.2%) also decreased. Although a reduction in seclusion rates was observed for Forensic (-4.6%) and Child and adolescent (-3.9) services, some variability was observed over time.
Source: State and territory governments, unpublished.Source data Admitted patient mental health-related care Table AD.17 (344KB XLS).
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