Involuntary treatment in public mental health care

This section presents information on involuntary treatment in Australian public mental health services. It includes community (day), residential (overnight) and admitted hospital services.

Acute hospitalisations consistently have the highest rate of involuntary treatment nationally, 50% in 2023–24, followed by non-acute hospitalisations (27%), residential care episodes (17%) and community care contacts (15%). The proportion of involuntary treatment and trends over time vary by jurisdiction.

The proportion of involuntary treatment is typically higher for males than females across all care settings, and higher for Aboriginal and Torres Strait Islander (First Nations) people than non-Indigenous people for admitted hospital and community settings.

People with a diagnosis of Schizophrenia or Schizoaffective disorder have higher proportions of involuntary treatment in community and residential settings (data not currently available for hospital settings).

Each state and territory has legislation relating to the rights and treatment of people with mental illness in health care. Certain conditions must be met for services to provide involuntary assessment, admission and/or treatment. Treatment may include medication and/or other therapeutic interventions.

Legal approval is needed to order involuntary treatment. It must be shown:

• the person has a mental illness
• there is serious risk of harm to the health of the person or the safety of the person or public 
• there is no less restrictive way to provide treatment (RANZCP 2017).

Involuntary treatment is a type of restrictive practice in a care setting. A restrictive practice is any practice or intervention that restricts a person’s rights (Australian Government 2014; SQPSC 2016).

The National Mental Health Consumer and Carer Forum maintains involuntary treatment and other restrictive practices are avoidable and preventable, and that involuntary treatment use remains too high (NMHCCF 2020).

Other examples of restrictive practices are:

• Seclusion.

  
  When a person is put alone in a room or area and they cannot leave by themselves. An example is a room with a door that locks and unlocks from the outside.

• Physical restraint.

  
  When staff use their hands or body to stop a person moving their body freely.

• Mechanical restraint.

  
  When items are used on a person’s body to stop them moving their body freely. Examples are belts or straps on a person’s hands or arms.

More information is available in the Seclusion and restraint report.

Involuntary treatment use in admitted hospital mental health care is one of the Key Performance Indicators for Australian public mental health services. Data on these indicators are reported on the AIHW's Mental Health Online Report. See data sources for more information.

Hospital services provide specialised mental health care for people admitted to a psychiatric hospital or psychiatric unit in a hospital. Over the last 5 years, national involuntary treatment use in hospitalisations has:

• increased to 50% in 2023–24 after being stable around 47% for acute (short-term care) units
• decreased from 31% to 27% for non-acute (rehabilitation and extended care) units.

Community services provide specialised mental health care for people living in the community, while residential services provide specialised mental health care for people staying overnight in a domestic-like environment. Over the past decade, the national proportion of involuntary treatment has:

• increased from 13% to 15% for community care contacts
• decreased from 20% to 17% for residential care episodes.

Western Australia has consistently reported among the lowest proportions of involuntary treatment in acute service settings. The jurisdiction(s) with the highest involuntary treatment rate varies by service setting.

Patient days is the number of days a person received care during a mental health-related hospitalisation.

Nationally, involuntary treatment was used for 60% of patient days in acute public mental health care in 2023–24. Involuntary treatment is generally higher when expressed as a proportion of patient days compared to hospitalisations, suggesting people who receive involuntary treatment have greater lengths of stay on average.

The relationship between demographic factors and involuntary treatment in mental health care varies by country (Curley et al. 2016, Walker et al. 2019). This is partly due to differences in legal frameworks, cultural perspectives and health care systems.

In Australia, the proportion of involuntary patient days and hospitalisations are generally highest for adults in age groups between 25 and 49 years of age.

Involuntary treatment as a proportion of patient days and hospitalisations is generally lower for adults aged 65 years and over, however in some collection years, rates are relatively high for some older age groups in admitted or residential care settings.

People aged 18–24 have one of the highest rates of mental health hospitalisations (AIHW 2025a) and residential care episodes (AIHW 2025c), but low or moderate rates of involuntary treatment compared to other age groups. Similarly, people aged 12–17 have the highest rate of community care contacts (AIHW 2025b) but one of the lowest rates of involuntary treatment.

Involuntary treatment was used for around 7% of acute mental health hospitalisations of children aged 5–11 years and around 22% of children aged 12–17 years.

Proportions of involuntary episodes were higher for males across all settings. The proportion of involuntary service contacts in community care with males has increased from 15% to 20% over the last decade.

First Nations people had higher proportions of involuntary treatment in hospital and community settings. Proportions of involuntary treatment for First Nations people have decreased over time for non-acute hospitalisations and residential care and increased for community care and acute hospitalisations.

The rate of mental health hospitalisations, community service contacts and residential care episodes for First Nations people is more than twice that of non-Indigenous people (AIHW 2025a, 2025b, 2025c). For community mental health services, the population rate of involuntary treatment (the rate per 100,000 population) for First Nations people is over 5 times that of non-Indigenous people.

In this report, areas are classified by level of socioeconomic disadvantage using SEIFA quintiles. In residential and community mental health care, proportions of involuntary treatment were highest for people living in the most and least-disadvantaged socioeconomic areas (SEIFA Quintiles 1 and 5, respectively). 

People living in areas of greater socioeconomic disadvantage had higher total population rates (per 100,000 people) of receiving involuntary treatment in community and residential mental health care settings.

In this report, areas are classified by level of geographical remoteness using the Remoteness area classification. Since 2015–16, the proportion of involuntary treatment episodes for community mental health care has been highest for people living in Major cities. The highest proportion of involuntary treatment episodes for residential mental health care was for people living in Inner regional and Outer regional areas in 2023–24.

Figure Invol.5 Involuntary treatment for common mental health-related diagnoses in Australian public mental health care by service setting, 2014–15 to 2023–24

The six most commonly reported diagnoses in community and residential public mental health services are shown in Table 1.

Note: Excludes the non-specific category Mental disorder not otherwise specified. This is the most frequently recorded mental health-related principal diagnosis for public mental health community services.

Source: Residential Mental Health Care Database and Community Mental Health Care Database, 2023–24

Figure 5 shows the proportion of involuntary treatment for mental health-related diagnoses in community and residential care. Data is not available on the proportion of involuntary treatment by diagnosis in hospital settings at the time of publication.

People with a diagnosis of Schizophrenia or Schizoaffective disorders have the highest proportions of involuntary treatment in community and residential care settings (35–42%).

Some diagnoses are less common but have higher proportions of involuntary treatment:

• 27% of community care contacts and residential care episodes where the person has a diagnosis of Unspecified nonorganic psychosis are involuntary
• 28% of community contacts where the person has a diagnosis of Mental and behavioural disorders due to multiple drug use and use of other psychoactive substances are involuntary
• 30% of community care contacts where the person has a diagnosis of Persistent delusional disorders are involuntary.

Involuntary mental health treatment may impact the therapeutic relationship between consumers and providers (Saya et al. 2019, Wyder et al. 2015). The National Mental Health Consumer and Carer Forum states involuntary treatment “precludes the development of trust and respect between consumers and families/carers and clinical staff, leading to fear and distress among consumers and a breakdown of therapeutic relationships” (NMHCCF 2020).

Your Experience of Service (YES) survey data provided to the AIHW from New South Wales, Victoria and Queensland shows surveys completed by people who received involuntary treatment were less likely to indicate a positive experience of service. For more information, see Consumer experiences in public mental health services.

Comparing involuntary treatment between countries is challenging due to limited data availability and/or differences in definitions, data collection, practice guidelines and legal conditions (WHO 2021a, 2021b; OECD 2021).

Internationally, reporting on mental health care performance and quality has improved since performance indicators were introduced by the OECD in 2013.

The EUNOMIA project, conducted from 2003 to 2006 (European Evaluation of Coercion in Psychiatry and Harmonisation of Best Clinical Practice), assessed the clinical practice of involuntary mental health hospitalisations in 12 European countries. The study found:

• The frequency of involuntary hospital treatment varied greatly between countries, partly because of sociocultural differences
• Factors such as hospital structures or staffing levels did not influence rates of involuntary treatment (Raboch et al. 2010, Kalisova et al. 2014).

Data collection on involuntary treatment is an objective of the World Health Organization’s Comprehensive Mental Health Action Plan 2013–2030 (WHO 2021a). Data are collected globally under the Mental Health Atlas. In 2020:

• 171 out of the 194 member states (88%) at least partially contributed data
• 10% of the total number of admissions to inpatient facilities across countries were involuntary
• Australia, Canada, and New Zealand did not report the number of involuntary admissions in hospital mental health care (WHO 2021b).

In a study of 22 countries across Europe, Australia and New Zealand using the most recent data from each country since 2013:

• Australia had the second highest population incidence of involuntary hospitalisation (227 per 100,000 people in 2016)
• The rate in Australia was more than double the mid-point of 106 among the countries studied, with the highest rate in Austria (282) and the lowest in Italy (15) (Rains et al. 2019).

The OECD (2021) reported the number of days a person can be held involuntarily under mental health legislation without review of a judge, in 22 countries:

• In some countries (including Belgium) people can be held for 24 hours or less
• In almost half (10 out of 22) of the countries (including Canada) people can be held for 1–3 days
• Some countries (including Japan) do not have a limit on the duration of involuntary hospitalisation
• In countries with federated governments, such as Australia, there is no national legislation and states/territories have their own legal frameworks for how long a person can be held without review (OECD 2021).

A person’s mental health legal status indicates if their treatment was on an involuntary basis.

Information on legal status data is collected by state and territory governments and supplied to the AIHW for national reporting. Mental health legal status is recorded for service contacts, episodes, hospital separations, or hospital patient days, depending on the service setting (data source) as specified in the data sources section.

In Australia, people can receive mental health treatment on an involuntary basis in community or ambulatory care (involuntary service contacts), residential care (involuntary episodes of care), and/or hospital care settings (involuntary hospitalisations or patient days):

• In community mental health services, care is recorded as involuntary if the person is receiving care on an involuntary basis at the time of contact
• For residential services, care is recorded as involuntary if the person received involuntary treatment at any time during their period of mental health care – the person may not have been given treatment involuntarily for the entire period of care
• Like residential care, a hospitalisation is coded as involuntary if the person received involuntary treatment at any time during the care period – patients may not be given involuntary treatment for their entire hospitalisation. Similarly, a patient day is coded as involuntary if the person received involuntary treatment at any time on that day.

Direct comparison between settings is not possible due to different counting units and criteria.

This report sources data from the Key Performance Indicators for Australian Public Mental Health Services (MHS KPIs), which were established in 2017 to report on involuntary treatment in mental health hospitals. Refer to data sources for more information about these indicators.

Prior to data being available under the MHS KPIs, data on hospital involuntary treatment were sourced from the admitted patient care National Hospital Morbidity Database (NHMD). These reports are still available on the Mental Health Online Report’s archived content, however caution is advised when comparing data from the NHMD with data from the MHS KPIs. 

The two datasets have differences in scope and other specifications. The following key differences contribute to the understanding of involuntary treatment depending on data source:

• Inclusion: Admitted patients who are under a community treatment order may be excluded from counts of involuntary hospitalisations collected under the NHMD. In contrast, the scope of the MHS KPIs includes all types of treatment orders as defined by each jurisdiction’s legislation or policies, regardless of the service setting of the treatment order
• Hospital program type: The MHS KPIs added the collection of hospital program type, which enabled reporting involuntary treatment data separately for acute and other (non-acute) units 
• Time spent in involuntary care: The MHS KPIs collection added the collection of number of involuntary patient days, which enabled reporting to better understand how much hospital mental health care was delivered under involuntary status. 

A treatment order is a legal instrument which enables compulsory assessment and/or treatment of a person in a mental health service. The legislation for treatment orders varies by state or territory, but in general, treatment orders involve a process of application, review, and approval/rejection from a legal authority such as a tribunal, magistrate or Chief Psychiatrist.

Each state and territory government reports information on activity of treatment orders in public annual reports. Reporting of service contacts with a mental health legal status of Involuntary will differ from reporting of treatment orders in the community by state and territory Chief Psychiatrists due to differences in statistical unit, collection scope and jurisdictional data systems.

Time series comparisons should be interpreted with care and comparisons between states and territories should be made with caution. Changes to state and territory legislation and data collection methods can result in changes in the recording of contacts or episodes with involuntary legal status.

Apparent increases in Involuntary legal status in community and residential mental health care settings in New South Wales in 2018–19 is a reflection of poorer data quality in previous years. Information system transition and changed business practices impacted legal status from 2015–16. Similarly, improved data collection practices in government-operated services in Tasmania have led to an increase in the reported number of involuntary episodes in 2014–15.

The number of residential episodes with involuntary mental health legal status is likely to be understated for South Australia for the 2013–14 reporting period due to a data and reporting issue which also affects the national total. 

Due to a change in the ACT’s information system, data on mental health legal status were not available for the 2023–24 reference period in community settings at the time of publication.

More information can be found in the Community mental health care NMDS 2023–24: National Community Care Database, 2025; Quality Statement and the Residential mental health care NMDS 2023–24: National Residential Mental Health Care Database, 2025; Quality Statement.

Mental health legal status information is collected for the National Community Mental Health Care Database (NCMHCD) – which has coverage from 2000 – and is collected for each service contact. 

Refer to the CMHC NMDS Data Quality Statement. Previous years' data quality statements are also accessible via METEOR. Data from this collection are published online annually on AIHW’s Mental Health Online Report under Community mental health care services.

Mental health legal status has been collected for the National Residential Mental Health Care Database (NRMHCD) since 2004 and is collected for each episode of care.

Refer to the RMHC NMDS Data Quality Statement. Previous years' data quality statements are also accessible in METEOR. Data from this collection are published online annually on AIHW’s Mental Health Online Report, under Residential mental health care services.

Under the Fifth National Mental Health and Suicide Prevention Plan (2017–2022) the proportion of involuntary hospitalisations to specialised mental health services was introduced as national Performance Indicator (PI) 23: Rate of involuntary hospital treatment (NMHC 2020, COAG 2017).

The two involuntary indicators have been included in the Key Performance Indicators for Australian Public Mental Health Services (Jurisdictional level) indicator set since 2021.

For more detail on the indicators, refer to KPIs for Australian Public Mental Health Services: PI 17aJ – Involuntary hospital treatment, 2025 and KPIs for Australian Public Mental Health Services: PI 17bJ – Involuntary patient days, 2025. Data from these indicators are published online annually on AIHW’s Mental Health Online Report, under Performance Indicators for mental health care.

Data are supplied under the YES National Best Endeavours Data Set agreement. New South Wales, Queensland and Victoria currently supply data to the AIHW under this agreement and this is published online annually on the Mental Health Online Report under Consumer experience in public mental health services. More information about the survey instrument, data methodology, and data quality over time can also be found in the report.

Australian Government (2014) National Framework for Reducing and Eliminating the Use of Restrictive Practices in the Disability Service Sector (the ‘National Framework’), accessed 12 December 2025.

AIHW (Australian Institute of Health and Welfare) (2025a) Admitted patient mental health-related care, Mental Health Online Report, AIHW website, accessed 12 December 2025.

AIHW (2025b) Community mental health care services, Mental Health Online Report, AIHW website, accessed 12 December 2025.

AIHW (2025c) Residential mental health care services, Mental Health Online Report, AIHW website, accessed 12 December 2025.

CHC (COAG [Council of Australian Governments] Health Council) (2017) The Fifth National Mental Health and Suicide Prevention Plan, Department of Health, Canberra.

Curley A, Agada E, Emechebe A, Anamdi C, Ting Ng X, Duffy R and Kelly BD (2016) ‘Exploring and explaining involuntary care: The relationship between psychiatric admission status, gender and other demographic and clinical variables’, International journal of law and psychiatry, 47:53–9, doi:10.1016/j.ijlp.2016.02.034.

NMHCCF (National Mental Health Consumer & Carer Forum) (2020) Restrictive Practices in Australian Mental Health Services, NMHCCF website, Canberra, accessed 12 December 2025.

NMHC (National Mental Health Commission) (2020) Fifth National Mental Health and Suicide Prevention Plan: 2019 Progress Report 2020, NMHC website, Sydney, accessed 12 December 2025.

OECD (Organization for Economic Co-operation and Development) (2021) A new benchmark for mental health systems, OECD website, accessed 12 December 2025.

Raboch J, Kalisova L, Nawka A, Onchev G, Karastergiou A, Magliano L, Dembinskas A, Kiejna A, Torres-Gonzales F, Kjellin L, Priebe S and Kallert TW (2010) ‘Use of Coercive Measures During Involuntary Hospitalization: Findings from Ten European Countries’, Psychiatric Services, 61(10):1012–1017, doi: 10.1176/ps.2010.61.10.1012.

Rains, SL, Zenina, T, Dias, MC, Jones, R, Jeffreys, S, Branthonne-Foster, S, Lloyd-Evans, B, and Johnson, S (2019) ‘Variations in patterns of involuntary hospitalisation and in legal frameworks: an international comparative study’, The Lancet Psychiatry, 6(5): 403-417. doi:10.1016/S2215-0366(19)30090-2.

RANZCP (Royal Australian and New Zealand College of Psychiatrists) (2017) Involuntary commitment and treatment – mental health legislation, RANZCP website, Melbourne, accessed 12 December 2025.

Saya A, Brugnoli C, Piazzi G, Liberato D, Di Ciaccia G, Niolu C and Siracusano A (2019) ‘Criteria, Procedures, and Future Prospects of Involuntary Treatment in Psychiatry Around the World: A Narrative Review,’ Frontiers in psychiatry,10:271, doi:10.3389/Ffpsyt.2019.00271.

SQPSC (Safety and Quality Partnership Standing Committee) (2016) National Principles for Communicating about Restrictive Practices with Consumers and Carers, NMHC website, accessed 12 December 2025.

Walker S, Mackay E, Barnett P, Sheridan Rains L, Leverton M, Dalton-Locke C, Trevillion K, Lloyd-Evans B and Johnson S (2019) ‘Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis’, The Lancet Psychiatry, 6(12): 1039-1053. doi:10.1016/S2215-0366(19)30406-7

WHO (World Health Organisation) (2021a) Comprehensive mental health action plan 2013-2030, WHO website, accessed 12 December 2025.

WHO (2021b) Mental health atlas 2020, WHO website, accessed 12 December 2025.

Wyder M, Bland R, Blythe A, Matarasso B and Crompton D (2015) ‘Therapeutic relationships and involuntary treatment orders: Service users' interactions with health-care professionals on the ward’, International Journal of Mental Health Nursing, 24(2):181–189, doi:10.1111/inm.12121.