Restrictive practices

This section reports national data on the use of seclusion (when a person is confined alone in a room or area where free exit is prevented) and restraint (when a person’s freedom of movement is restricted by physical or mechanical means) in specialised mental health public hospital acute service units.

Data are also reported on the treatment of people on an involuntary basis under legislated state and territory mental health acts in public acute and psychiatric hospitals, residential mental health services, and community mental health care services.

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 acknowledges this point of view in its position statement Minimising the use of seclusion and restraint in people with mental illness (RANZCP 2016), which advocates that seclusion should only be used as a safety measure of last resort where all other interventions have been considered. The Australian National Mental Health Commission’s (NMHC) 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.”

Working towards 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 Standing Committee (SQPSC) and Mental Health Information Strategy Standing Committees  (Allan et al. 2017, SQPSC 2017). Twelve national forums on restrictive practices have been held, the most recent in November 2018, to share results and support broader change efforts to shift seclusion and restraint out of mental health units entirely.

Data on the use of seclusion, mechanical and physical restraint by hospital was 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.

Data downloads

Restrictive practices 2018–19 tables (660KB XLS)

Restrictive practices 2018–19 section (384KB)

Data coverage includes the time period 2008–09 to 2018–19. This section was last updated in January 2020.

Key points

 

  • 14.5% of community mental health care service contacts were for people with an involuntary legal status in 2017–18.
  • 44.0% of separations and 57.3% of patient days in acute care were for involuntary care in 2017–18.
  • 7.3 seclusion events per 1,000 bed days were reported for acute specialised mental health hospital services in 2018–19, down from 13.9 in 2009–10.
  • 4.2 hours was the average seclusion duration in 2018–19.
  • 11.3 physical restraint events per 1,000 bed days and 0.6 mechanical restraint events per 1,000 bed days were reported in 2018–19.

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. An individual’s mental health legal status defines if their treatment was on an involuntary basis.

Each state and territory’s mental health act and associated regulations provide the legislative frameworks that safeguard the rights and governs the treatment of patients with mental illness. Legislation varies between states and territories but all contain provisions for the assessment, admission and treatment of patients on an involuntary basis, which, in this report, is 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 for 2017–18 was in admitted units, where nearly half (45.8%) of public hospital overnight mental health-related separations with specialised psychiatric care were involuntary at some stage during the separation. Around 1 in 5 residential mental health care episodes (20.0%) and 1 in 7 community mental health care service contacts (14.5%) were also involuntary in 2017–18 (Figure RP.1).

 
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Figure RP.1 Alternative text - Source data: Restrictive practices tables (660KB XLS).

A separation is coded as involuntary if the patient has received involuntary treatment at any time during the admission; however not all patients remain involuntary for the full period of their admission to hospital. Data are now available for the first time on the proportion of patient days that were involuntary. In 2017–18, 57.3% of patient days in Acute units and 41.3% of patient days in Other (non-acute) units were involuntary. People aged 35–39 years had the highest proportion of involuntary separations and patient days in both Acute and Other units.