Mental health
Seclusion and restraint
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Content warning
This report contains information some readers may find distressing as it refers to data about people who were secluded or restrained while in hospital mental health care.
On this page:
Seclusion is when a person is placed alone in a room and cannot leave by themselves. An example is a room with a door that locks and unlocks from the outside.
Restraint is when a person is held to stop them moving their body. Mechanical restraint is when items are used, such as tying belts or straps on their hands or arms. Physical restraint is when staff use their hands or body to stop a person moving freely.
This page shows national, state and territory and hospital data on the use of seclusion and restraint in Australian public hospital mental health care. Only acute units (providing short-term care) are covered. More data on the use of seclusion and restraint, including data breakdowns by state/territory and service target population, are available in the data tables download and on the Mental health performance indicators page.
Key points
In one year (2024–25), Australian public hospital mental health care had:
11,130 seclusion events of 6 hours average duration
963 mechanical restraint events
15,912 physical restraint events
Related indicator set: Key Performance Indicators for Australian public mental health services – Seclusion and restraint indicators.
Spotlight data
Figure SECREST.Spotlight: Seclusion and restraint rate (events per 1,000 bed days), 2009–10 to 2024–25
Definitions and line graphs of seclusion, mechanical and physical restraint rates in Australia. Further description of the figure is available following this image. Refer also to Table SECREST.1.
Notes: Queensland did not collect information on physical restraint events prior to 2017–18.
Source: National Seclusion and Restraint Database, Table SECREST.1.
- Seclusion is when a person is locked alone in a room and cannot leave by themselves. The national seclusion rate (events per 1,000 bed days) decreased from 14 in 2009–10 to 6 in 2024–25. This is real change in how services used seclusion.
- Mechanical restraint is when items are used on a person’s body to stop them moving freely, such as belts or straps. Mechanical restraint is relatively low, with a national rate of 2 events per 1,000 bed days in 2015–16 and 1 in 2024–25.
- Physical restraint is when staff use their hands or body to stop a person moving freely. The physical restraint rate has been steady between 9 and 12 events per 1,000 bed days since 2015–16, the rate was 9 events in 2024–25.
Related indicator set: Key Performance Indicators for Australian Public Mental Health Services - Seclusion and restraint.
In Australia there are legal and regulatory frameworks which govern the use of seclusion and restraint in mental health care under some circumstances. All states and territories collect data on the use of seclusion and restraint in public acute mental health hospitals and provide data for national reporting every year.
How often do seclusion and restraint happen in Australia?
Data on seclusion for most states and territories are available from 2008–09:
- The national seclusion rate has more than halved from 2009–10 to 2024–25
- People in acute hospital care were secluded 11,130 times during 2024–25, a rate of 6 events per 1,000 bed days
- Seclusion lasted for 6 hours on average, excluding Forensic services
- Duration of seclusion for Forensic services is calculated separately. In 2024–25 seclusion in Forensic services lasted for 35 hours on average.
Data on restraint are available from 2015–16:
- There were 15,912 physical restraint events (9 events per 1,000 bed days) and 963 mechanical restraint events (1 event per 1,000 bed days) during 2024–25
- Since data coverage began, the national physical restraint rate has been essentially steady. Mechanical restraint has a consistently lower rate than seclusion and physical restraint. Rates of physical restraint are consistently higher than seclusion and mechanical restraint rates.
Seclusion and restraint rates for the states and territories and hospitals are also available in this report.
Data are also reported under the Mental health performance indicators:
- Of all service types, Forensic services had the highest rates of seclusion, mechanical and physical restraint in 2024–25.
Work towards establishing a national collection for seclusion data began in 2011 (Allan et al. 2017), with restraint data included a few years later. The collection and improvement of data on the use of seclusion and restraint in Australian mental health care is an ongoing initiative. Annual reporting continues through cooperative efforts in the mental health data sector, particularly with the coordinated efforts of state/territory mental health authorities and national government agencies.
How often do seclusion and restraint happen?
Figure SECREST.1: Number and rate of seclusion and restraint events in public mental health hospital care in Australia, 2009–10 to 2024–25
Line graphs of seclusion, mechanical and physical restraint events in Australia by number and rate. Further description of the Figure is available following this image. Refer also to Table SECREST.1.
| Year | Number of seclusion events | Number of mechanical restraint events | Number of physical restraint events |
|---|---|---|---|
| 2009–10 | 18,089 | . . | . . |
| 2010–11 | 16,135 | . . | . . |
| 2011–12 | 14,901 | . . | . . |
| 2012–13 | 14,109 | . . | . . |
| 2013–14 | 12,161 | . . | . . |
| 2014–15 | 12,101 | . . | . . |
| 2015–16 | 12,713 | 2,671 | 14,551 |
| 2016–17 | 11,937 | 1,479 | 13,335 |
| 2017–18 | 11,343 | 797 | 16,959 |
| 2018–19 | 11,960 | 991 | 18,740 |
| 2019–20 | 13,498 | 1,213 | 18,356 |
| 2020–21 | 12,381 | 1,111 | 19,708 |
| 2021–22 | 10,851 | 1,522 | 16,996 |
| 2022–23 | 9,977 | 1,128 | 16,702 |
| 2023–24 | 9,424 | 783 | 15,143 |
| 2024–25 | 11,130 | 963 | 15,912 |
| Year | Rate of seclusion | Rate of mechanical restraint | Rate of physical restraint |
|---|---|---|---|
| 2009–10 | 14 | . . | . . |
| 2010–11 | 12 | . . | . . |
| 2011–12 | 11 | . . | . . |
| 2012–13 | 10 | . . | . . |
| 2013–14 | 8 | . . | . . |
| 2014–15 | 8 | . . | . . |
| 2015–16 | 8 | 2 | 11 |
| 2016–17 | 7 | 1 | 10 |
| 2017–18 | 7 | Rounded to 0 | 10 |
| 2018–19 | 7 | 1 | 11 |
| 2019–20 | 8 | 1 | 11 |
| 2020–21 | 7 | 1 | 12 |
| 2021–22 | 7 | 1 | 10 |
| 2022–23 | 6 | 1 | 10 |
| 2023–24 | 5 | Rounded to 0 | 9 |
| 2024–25 | 6 | 1 | 9 |
Notes
- Rates are rounded to the nearest whole number. A rate of 0 may include where seclusion and restraint has occurred, but the overall rate has been rounded to 0.
- Queensland did not collect information on physical restraint events prior to 2017–18.
Source:
National Seclusion and Restraint Database, Table SECREST.1.
Figure 1 shows the number of times seclusion and restraint events were recorded in Australian public hospital mental health care since data was first provided by all states and territories in 2009–10. It also shows the rate of these events per 1,000 bed days:
- Nationally during 2024–25, there were 11,130 seclusion events with a rate of 6 events per 1,000 bed days.
- Data on restraint are available since 2015–16. Nationally there were 15,912 physical restraint events and 963 mechanical restraint events during 2024–25, rates are 9 and 1 events per 1,000 bed days respectively.
Figure SECREST.2: Duration of seclusion events in public mental health hospital care in Australia, 2013–14 to 2024–25
Bar graph showing average duration of seclusion events in Australian public hospitals from 2013–14. Further description of the Figure is available following this image. Refer also to Table SECREST.1.
| Year | Hours |
|---|---|
| 2013–14 | 6 |
| 2014–15 | 6 |
| 2015–16 | 5 |
| 2016–17 | 6 |
| 2017–18 | 5 |
| 2018–19 | 4 |
| 2019–20 | 5 |
| 2020–21 | 5 |
| 2021–22 | 6 |
| 2022–23 | 6 |
| 2023–24 | 6 |
| 2024–25 | 6 |
Notes
- Average duration of seclusion does not include South Australia prior to 2018–19.
- Due to data comparability issues for events occurring in Forensic services, all Forensic service events are excluded from the average duration analysis.
Source:
National Seclusion and Restraint Database, Table SECREST.1.
Figure 2 shows how long seclusion lasted, in average hours, in Australian public mental health care during the last decade.
- Nationally during 2023–24, seclusion lasted for 6 hours on average, excluding Forensic services.
Rates of seclusion and restraint vary between states and territories:
- The seclusion rate in 7 of the states and territories has fallen since the first year of data availability (2009–10 for SA and NT, 2008–09 for all other states and territories).
- In 2024–25, the rate of seclusion varied between 4 and 9 events per 1,000 bed days and physical restraint events ranged from 6 to 13.
- All states and territories reported mechanical restraint rates equal to or less than 1 event per 1,000 bed days in 2024–25.
Refer to Table 2 State/territory data in Data tables: Seclusion and restraint in mental health care 2024–25.
Hospital level seclusion and restraint data are available from 2016–17.
Rates of seclusion and restraint vary between public hospitals providing acute specialised admitted mental health care. Variation may be due to many factors including the service setting, case mix and patient characteristics (Oster et al, 2016; Beghi et al 2013).
In 2024–25 seclusion rates ranged from 0–32 events per 1,000 bed days in Australian public hospitals, mechanical restraint from 0–11 and physical restraint from 0–41.
Of 138 Australian public hospitals providing acute specialised admitted mental health care:
- 17% had a seclusion rate of 0 (24 hospitals),
- 63% had a mechanical restraint rate of 0 (87 hospitals), and
- 6% had a physical restraint rate of 0 (8 hospitals).
Refer to Table 3 Hospital data in Data tables: Seclusion and restraint in mental health care 2024–25.
Seclusion and restraint in practice
Seclusion and restraint are examples of restrictive practices in a care setting. A restrictive practice is any practice or intervention that restricts a person’s rights, including their freedom to move (Australian Government 2014; SQPSC 2016).
Minimising the use of seclusion and restraint in mental health services is a key focus across multiple sectors – including consumers, carers, governments and services. The National Mental Health Consumer and Carer Forum maintains that seclusion and restraint and other restrictive practices are avoidable and preventable (NMHCCF 2021). The Royal Australian and New Zealand College of Psychiatrists acknowledges in its position statement that seclusion and restraint should only be used “…as a safety measure of last resort where all other interventions…” were considered (RANZCP 2021).
All Australian states and territories have legislation and regulations on the rights and treatment of people with mental illness in health care. Legislation varies between states and territories but all include criteria for when and where seclusion and restraint may be used.
Seclusion and/or restraint in health services can be used to provide safety and containment when necessary to protect patients, health service staff and others. However, use of these practices can also be distressing for the consumer, support people, representatives, other patients, staff and visitors. Therefore advice is that wherever possible, alternative ways of managing a consumer’s behaviour should be used instead of seclusion and restraint (RANZCP 2021).
“…Seclusion and restraint should only be used in accordance with approved protocols and best practice by properly trained professional staff in an appropriate environment…” (RANZCP 2021). More information about seclusion and restraint for Australian and New Zealand mental health legislation is available on the RANZCP website (RANZCP 2017a, 2017b).
Seclusion and restraint during a hospital stay can have a negative impact on a person’s recovery
Some people with mental illness and their carers advocate that restrictive practices do not benefit the consumer and that these interventions infringe on human rights, are anti-therapeutic and compromise the therapeutic relationship between the consumer and the clinician (Melbourne Social Equity Institute 2014; NMHCCF 2021).
Seclusion and restraint in mental health settings can affect everyone involved, including patients, carers and health care staff.
A person’s experience of seclusion or restraint can vary. Research in this area identifies a range of factors that can impact a person’s experience and long term effects on mental health care. Common factors are physical environment and the extent of consumer and carer engagement in the service.
Rates of seclusion and restraint are included in the Key Performance Indicators for Australian Public Mental Health Services. These indicators contribute to measuring the performance and progress of mental health services in Australia. The indicators are also reported on the Performance indicators monitoring page. Refer to the data source section for more information.
It is a policy priority in Australian mental health care to work towards eliminating seclusion (CHC 2017; National Mental Health Working Group 2005 as cited in NMHPSC 2013). This has been supported by changes to legislation, policy and clinical practice as well as:
- former national mental health committees, including the Safety Quality Partnership Standing Committee and Mental Health Information Strategy Standing Committee (Allan et al. 2017, SQPSC 2017)
- the Towards Eliminating Restrictive Practices (TERP) Forum, supported by all governments to share results, best practice and change to remove seclusion and restraint practices in mental health
- the National Mental Health Commission’s Statement on seclusion and restraint in mental health, which called for leadership including “…national monitoring and reporting on seclusion and restraint across jurisdictions and services” (NMHC 2015).
Where can I find more information?
Many people improve clinically after care from public mental health services. Improvement is seen after about 75% of hospital care episodes according to clinician-rated measures. More information is available in the Consumer outcomes report.
If the information presented raises any issues for you, these resources can help:
- Lifeline (Phone 13 11 14)
- Kids Helpline (Phone 1800 551 800)
- Medicare Mental Health portal
Notes to interpret the data
Rates are a way to calculate how often something happens in relation to something else. An example is the number of mental health-related prescriptions that are given for every 1,000 people.
In this report, rates are used to describe how often seclusion and restraint happen in Australian public hospital mental health services against a set number of days that a patient (or patients) used a bed in a service or group of services. This is known as patient days or bed days. This report uses statements to report the number of seclusion or restraint events for every 1,000 bed days.
Why do we use rates?
Using only the number of events shows how much an event has happened. Without context, this number does not help us to draw any further conclusions. However, if we measure the number of events in relation to something else, like a period of time, we can determine how often it occurs. This also allows us to compare different groups, as we can measure each group in the same way.
An example
Using rates means that a large mental health service can be assessed in the same way as a smaller service and we can better compare their performance. Here is an example with two hypothetical services.
| Service | Number of seclusion events | Number of bed days | Rate of seclusion |
|---|---|---|---|
| Service A | 100 | 10,950 | 9 events per 1,000 bed days |
| Service B | 50 | 4,015 | 12 events per 1,000 bed days |
Service A reports more seclusion events than Service B (100 vs 50). Using these numbers alone, it appears that Service A uses seclusion more than Service B. However Service A is a larger service with more bed days, showing it has more service activity than Service B (10,950 vs 4,015). If we convert the number of seclusion events to a rate, we can see that Service A actually uses seclusion less often than Service B compared to the amount of activity the service provides (9 vs 12).
By assessing the activity of the two services against the same measurement (a rate), their activity can be compared despite the difference in size.
Target population represents the age group that the mental health service is intended to serve, not the age of individual patients.
Forensic services provide services largely for people whose health condition has led them to commit, or be suspected of committing, a criminal offence or makes it likely that they will reoffend without adequate treatment or containment. The average duration of a seclusion event is reported excluding Forensic services, as forensic seclusion events are typically of longer duration, and substantially skew the overall duration average.
Data source
Seclusion and restraint data reported in this section are from the National Seclusion and Restraint Database (NSRD). Data are supplied by each Australian state and territory, under the Mental health Seclusion and Restraint National Best Endeavours Data Set (SECREST NBEDS) agreement. Historical data are available from 2008–09 for seclusion and 2015–16 for restraint. Data on the use of seclusion and restraint by hospital were reported for the first time in December 2018. Public reporting enables services to review their individual results against other states and territories, national rates and like services, thereby supporting service reform and quality improvement agendas.
Although seclusion and restraint may occur across a range of mental health service settings, the scope of the NSRD and SECREST NBEDS is hospital units that provide specialised mental health care. Only acute units are included, which provide short-term care. This service setting has been the focus of many associated quality improvement initiatives, including data collection and reporting developments.
Data Quality Statements are published annually on METEOR. Statements provide information on the institutional environment, timeliness, accessibility, interpretability, relevance, accuracy and coherence. Refer to the Mental health seclusion and restraint NBEDS 2015–: National seclusion and restraint database, 2025; Quality Statement. Previous years' data quality statements are also accessible in METEOR.
Data from the National Seclusion and Restraint Database are also used for the Key Performance Indicators for Australian Public Mental Health Services (KPIs). These include the indicators KPI 15 Seclusion rate and KPI 16 Restraint rate which draw on the National Seclusion and Restraint Database for reporting.
The original KPI set was released in 2005, with the aim to measure and improve the performance of public mental health services. The indicators have been revised over time through the former National Mental Health Performance Subcommittee (NMHPSC) of the former Mental Health Information Strategy Standing Committee (MHISSC), to drive and incorporate improvements made to data sources, jurisdictional implementation and results of nation-wide projects (NMHPSC 2013).
Rate of seclusion was added to the national KPI set in 2011 (NMHPSC 2013) and rate of restraint was added in 2018. Both indicators fall under the priority area of safety in mental health services, in which reducing the use of seclusion and restraint is considered a key aspect (CHC 2017; National Mental Health Working Group 2005 as cited in NMHPSC 2013).
In 2022 the National Mental Health and Suicide Prevention Agreement and Bilateral Agreements were signed by the Australian Government and state and territory governments. While performance indicators for these agreements have not yet been established, seclusion and restraint are listed as priority data and Indicators for Development in the National Agreement (Australian Government 2022). Seclusion and restraint rates as measured in the KPIs will continue to be reported until indicators for the new National Agreement become available.
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Data coverage is 2008–09 to 2024–25 for seclusion, and 2015–16 to 2024–25 for restraint.