Transforming acute mental health care

Our challenge

Highlighting disparity across approaches in acute mental health settings

For centuries, restrictive practices known as seclusion and restraint were the norm in acute mental health settings to manage the behaviour of people suffering from psychiatric illnesses. Currently in Australia, such practices are widely considered a violation of human rights with detrimental outcomes to patients. Hence, alternative clinical strategies are required.

Concerns about these practices in acute mental health settings were raised by patients and their families and carers over a decade ago, which led to improvements. Initially, clinicians began to reduce restrictive practices, and subsequently worked towards eliminating them. However, without a national picture of how, and to what extent, restrictive practices are being utilised, there is no standard for benchmarking and comparing the approaches of state and territory governments.

Our response

Monitoring the use of restrictive practices in mental health facilities

Working through the Australian Health Ministers’ Advisory Council, Australia’s 8 chief psychiatrists enlisted the assistance of the AIHW to develop a robust, national methodology to monitor the use of restrictive practices in mental health facilities.

In 2013, the AIHW released the first national figures on seclusion as part of its Mental health services in Australia report. Since then, we have updated and expanded these data yearly.

Our results

Greater understanding of clinical care

Over the 7 years since the AIHW started reporting on the use of seclusion, the incidence of the practice has halved, reflecting frontline changes in clinical care. While we are unable to attribute this fall to the availability of data, these data have made a contribution – otherwise it would be unknown whether seclusion was becoming more or less prevalent. In 2017, national restraint data were publicly available for the first time.

This case study provides a powerful example of the influence of data to support and drive change.

Dr Nathan Gibson, the Chief Psychiatrist of Western Australia, said that these data have served like a ‘powerful non-judgemental mirror’ held up to clinicians and mental health facilities, allowing them to see how they are performing.

‘This data has been a really explicit tool to actually say to people: “look how you’re functioning compared with the next place”,’ he explained. Dr Gibson recognises the AIHW as a leader in health and welfare data, as he said that ‘it’s the transparency of the data and the fact that it’s high quality. People trust it because it comes from the AIHW’.

The delivery of this sort of data to people who are on the ground doing the work completely changes their engagement; it actually drives quality improvement,’ said Dr Leanne Beagley, Chief Executive Officer (CEO) of Mental Health Australia. It demonstrates the AIHW’s contribution to informing improvements to acute mental health care nationally.