Seclusion and restraint in mental health care

 

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 data on the use of seclusion and restraint in Australian public hospital mental health care. Only acute units (providing short-term care) are covered.

Key points

In one year, Australian public hospital mental health care had:

10,851 seclusion events

1,522 mechanical restraint events

16,996 physical restraint events

Spotlight data

Three line graphs showing seclusion rate (events per 1,000 bed days) in Australia from 2009–10 to 2021–22 and mechanical and physical restraint rate from 2015–16 to 2021–22. Seclusion is the confinement of a person alone in a room and cannot leave by themselves. The national seclusion rate halved from 2009–10 to 2021–22. This is real change in how services use 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 consistently low, with a national rate of 2 events per 1,000 bed days in 2015–16 and 1 in 2021–22. Physical restraint is when staff use their hands or body to stop a person moving freely. The physical restraint rate has stayed consistent at 10 to 12 events per 1,000 bed days since 2015–16. Refer to Tables 1 and 4. 

Source: National Seclusion and Restraint Database, Tables SECREST.1 and 4. 


How often do seclusion and restraint happen?

Figure SECREST.1: Number of seclusion and restraint events in Australian public hospital mental health care

Figure SECREST.1.1. Bar graph showing the number of seclusion events in Australia from 2013–14 to 2021–22. A line overlaying the bars shows the average duration of seclusion in Australia for the same period. Refer to Table SECREST.1.

Figure SECREST.1.2. Bar graph showing the number of mechanical and physical restraint events in Australia from 2015–16 to 2021–22. Refer to Table SECREST.4. 

Notes: Due to data comparability issues for events occurring in Forensic services, all Forensic service events are excluded from the average duration analysis.

Average duration of seclusion does not include South Australia prior to 2018–19. Queensland did not collect information on physical restraint events prior to 2017–18. 

SourceNational Seclusion and Restraint Database, Tables SECREST.1 and SECREST.4

Figure SECREST.2: Rates of seclusion and restraint over time in Australian public hospital mental health care

Figure SECREST.2.1. Line graph showing seclusion events per 1,000 bed days for all states and territories from 2008–09 to 2021–22. There is an overall downward trend, with the exception of ACT. Refer to Table SECREST.1.

Figure SECREST.2.2. Line graph showing mechanical and physical restraint events per 1,000 bed days for all states and territories from 2015–16 to 2021–22. Mechanical restraint shows an overall downward trend, with the exception of NSW. Physical restraint shows an overall upward trend, with the exception of Vic where the rate has decreased over time. Refer to Table SECREST.4.

NotesRates are not calculated where numerators are less than 5 or denominators are less than 100 due to the potential for unreliable statistics.

Queensland did not collect information on physical restraint events prior to 2017–18. Comparisons between jurisdictions, between years, and for smaller jurisdictions should be undertaken with caution. 

SourceNational Seclusion and Restraint Database, Tables SECREST.1 and SECREST.4

Figure SECREST.3: Rates of seclusion and restraint over time by target population of Australian public hospital mental health care.

Figure SECREST.3.1. Line graph showing seclusion events per 1,000 bed days for General, Child and adolescent, Older persons, and Forensic target populations, from 2008–09 to 2021–22. Refer to Table SECREST.2.

Figure SECREST.3.2. Line graph showing mechanical and physical restraint events per 1,000 bed days for General, Child and adolescent, Older persons, and Forensic target populations, from 2015–16 to 2021–22. Refer to Table SECREST.5.

NoteQueensland did not collect information on physical restraint events prior to 2017–18. 

Source: National Seclusion and Restraint Database, Tables SECREST.2 and SECREST.5

Seclusion and restraint in practice

Figure SECREST.4: Rates of seclusion and restraint for individual Australian public hospital mental health care

Figure SECREST.4.1. Horizontal bar chart showing seclusion and mechanical and physical restraint events per 1,000 bed days in 2021–22 by hospital, excluding forensic units. Refer to Table SECREST.7.

Figure SECREST.4.2: Interactive text display showing seclusion and mechanical and physical restraint events per 1,000 bed days for each hospital in 2021–22. The user is able to select a particular hospital to display. Refer to Table SECREST.7.

Note: Due to data comparability issues for events occurring in Forensic services, all hospital level rates exclude Forensic services.

Source: National Seclusion and Restraint Database, Table SECREST.7

When can seclusion and restraint be used?

Where do I go for more information?

Many people improve clinically after care from public mental health services. Improvement is seen after about 72% of hospital care episodes according to clinician-rated measures (Gee et al. 2022). More information is in the Consumer outcomes report.

If the information presented raises any issues for you, these resources can help:

Notes to interpret the data

Data source

Key concepts

Key concept

Description

Bed days

Bed days (also known as patient days) means the occupancy of a hospital bed (or chair in the case of some same day patients) by an admitted patient for all or part of a day. The length of stay for an overnight patient is calculated by subtracting the date the patient was admitted from the date of separation and deducting days the patient was on leave. A same-day patient is allocated a length of stay of 1 day.

Bed day statistics can be used to provide information on hospital activity that, unlike separation statistics, account for differences in length of stay. The bed day data presented in this report include days within hospital stays that occurred before 1 July provided that the separation from hospital occurred during the relevant reporting period (that is, the financial year period). This has little or no impact in private and public acute hospitals, where separations are relatively brief, throughput is relatively high and the bed days that occurred in the previous year are expected to be approximately balanced by the bed days not included in the counts because they are associated with patients yet to separate from the hospital and therefore yet to be reported. However, some public psychiatric hospitals provide very long stays for a small number of patients and, as a result, would have comparatively large numbers of bed days recorded that occurred before the relevant reporting period and may not be balanced by bed days associated with patients yet to separate from the hospital.

Hospital mental health care

Hospital mental health care refers to specialised mental health services in a hospital or psychiatric hospital, which are staffed by health professionals with specialist mental health qualifications and/or training and have as their principal function the treatment and care of patients affected by mental illness.

There are two types of hospital mental health care. Acute care hospital programs involve short‑term treatment for individuals with acute episodes of a mental disorder, characterised by recent onset of severe clinical symptoms that have the potential for prolonged dysfunction or risk to self and/or others. Other or non‑acute care refers to all other admitted patient programs, including rehabilitation and extended care services (METEOR identifier 288889).

Seclusion and restraint data presented in this report are for Acute hospital mental health care only.

Restraint

Restraint is defined as the restriction of an individual's freedom of movement by physical or mechanical means.

Mechanical restraint

The application of devices (including belts, harnesses, manacles, sheets and straps) on a person's body to restrict his or her movement. This is to prevent the person from harming themselves or endangering others or to ensure the provision of essential medical treatment. It does not include the use of furniture (including beds with cot sides and chairs with tables fitted on their arms) that restricts the person's capacity to get off the furniture except where the devices are used solely for the purpose of restraining a person's freedom of movement.

The use of a medical or surgical appliance for the proper treatment of physical disorder or injury is not considered mechanical restraint.

Physical restraint

The application by health care staff of ‘hands-on’ immobilisation or the physical restriction of a person to prevent the person from harming themselves or endangering others or to ensure the provision of essential medical treatment.

Seclusion

 

 

 

 

 

 

 

 

 

Seclusion is defined as the confinement of a person at any time of the day or night alone in a room or area from which free exit is prevented.

Key elements include that:

  1. The person is alone.
  2. The seclusion applies at any time of the day or night.
  3. Duration is not relevant in determining what is or is not seclusion.
  4. The person cannot leave of their own accord.

The intended purpose of the confinement is not relevant in determining what is or is not seclusion. Seclusion applies even if the person agrees or requests the confinement. Seclusion also applies if the person agrees to or requests confinement of their own accord. However, if voluntary isolation or time alone is requested and the person is free to leave at any time then this is not considered seclusion.

The awareness of the person that they are confined alone and denied exit is not relevant in determining what is or is not seclusion. The structure and dimensions of the area to which the consumer is confined is not relevant in determining what is or is not seclusion. The area may be an open area, for example, a courtyard. Seclusion does not include confinement of people to High Dependency sections of gazetted mental health units, unless it meets the definition.

More information can be found in the data source section about jurisdictional consistency with this definition.

Target population

Some specialised mental health services data are categorised using 5 target population groups (see METEOR identifier 682403):

  • Child and adolescent services focus on those aged under 18 years.
  • Older person services focus on those aged 65 years and over.
  • Forensic health services provide services primarily for people whose health condition has led them to commit, or be suspected of, a criminal offence or make it likely that they will reoffend without adequate treatment or containment.
  • General services provide services to the adult population, aged 18 to 64, however, these services may also provide assistance to children, adolescents or older people.
  • Youth services target children and young people generally aged 16–24 years.

Note that, in some states, specialised mental health beds for aged persons are jointly funded by the Australian and state and territory governments. However, not all states or territories report such jointly funded beds.

Data coverage is 2008–09 to 2021–22 for seclusion, and 2015–16 to 2021–22 for restraint. This section was last updated in April 2023.