Restrictive practices

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 acknowledged this point of view in their position statement Minimising the use of seclusion and restraint in people with mental illness  (RANZCP 2016 ), balancing the negative aspects of seclusion and restraint against the need for interventions under certain circumstances. The Australian National Mental Health Commission’s (NMHC) Position 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 (SQPSC) and Mental Health Information Strategy Standing Committees (MHISSC). Eleven national forums on restrictive practices have been held, the most recent in May 2017, to share results and support broader change efforts to shift seclusion and restraint out of mental health units entirely.

Data on the use of mechanical and physical restraint was reported for the first time in May 2017. Public reporting enables services to review their individual results against state/territory, national rates and like services, thereby supporting service reform and quality improvement agendas.

Data downloads

Restrictive practices 2016–17 tables (635KB XLS)

Restrictive practices 2016–17 section (523KB)

Data coverage includes the time period 2008–09 to 2016–17. This section was last updated in February 2018.

Key points

  • 48.2% of mental health-related hospital separations with specialised psychiatric care were for people with an involuntary legal status in 2015–16.
  • 7.4 seclusion events per 1,000 bed days in acute specialised mental health hospital services in 2016–17, down from 13.9 in 2009–10.
  • 5.8 hours was the average seclusion duration in 2016–17.
  • 8.3 physical restraint events per 1,000 bed days and 0.9 mechanical restraint events per 1,000 bed days in 2016–17.

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.

Each state and territories mental health act and associated regulations provide the legislative cover that safeguards the rights and governs the treatment of patients with mental illness receiving care. Legislation varies between state and territories but all contain provisions for the assessment, admission and treatment of patients on an involuntary basis, 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 was in admitted units, where nearly half (48.2%) of all public hospital overnight mental health-related separations with specialised psychiatric care were involuntary at some stage during their separation. Note that patients may not remain involuntary for the full period of their admission to hospital, however the separation is coded as involuntary if the patient has received involuntary treatment at any time during the admission. Around 1 in 5 residential mental health care episodes (19.4%) and 1 in 10 community mental health care service contacts (13.5%) were involuntary in 2015–16 (Figure RP.1).

Source data: Restrictive practices (635KB XLS).