Key concepts

Restrictive practices
Key concept Description
Mental health legal status is defined as whether a person is treated on an involuntary basis under the relevant state or territory mental health legislation, at any time during an episode of admitted patient care, an episode of residential care or treatment of a patient/client by a community based service during a reporting period (METeOR ID 534063).
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 himself/herself 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 himself/herself or endangering others or to ensure the provision of essential medical treatment.

Seclusion

Seclusion is defined as the confinement of the consumer 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 consumer 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 consumer 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 consumer agrees or requests the confinement.

The awareness of the consumer 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 consumers 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 445778):

  • 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 through the National Mental Health Establishments Database.


Alternative text for Restrictive practices figures

 

Figure RP.1

Stacked bar chart showing the proportion of care by mental health legal status in three service settings in 2016–17. Mental health separations in public hospital services: 45.4% involuntary, 54.6% voluntary. Residential mental health care episodes: 19.0% involuntary, 81.0% voluntary. Community mental health care contacts: 13.8% involuntary, 86.2% voluntary. Refer to Table RP.1. Back to figure RP.1

Figure RP.2

Line graph showing the seclusion rate per 1,000 bed days for all states and territories from 2009–10 to 2016–17. The long term pattern of change shows reductions in all states and territories, other than the ACT, which for all years has had the lowest seclusion rate among all states and territories. Refer to Table RP.2. Back to figure RP.2

Figure RP.3

Vertical bar chart showing the average number of hours spent in seclusion per seclusion event, 2013–14 to 2016–17. Victoria was the highest for all years (9.5, 8.0, 8.3, 10.0). Three jurisdictions show a decreasing average duration of seclusion events from 2013–14 to 2016–17; NSW (6.0 to 5.5), Qld (3.8 to 2.7), Tas (4.1 to 1.8). Two jurisdictions show an increasing average duration of seclusion events from 2013–14 to 2016–17; WA (2.4 to 2.5) and ACT (2.1 to 2.3). NT reported variation across years (6.4, 7.9, 4.9, 6.4). National total was 6.0 to 5.8. Refer to Table RP.2. Back to figure RP.3

Figure RP.4

Line graph showing the rate of seclusion events per 1,000 bed days for the service unit target populations from 2009–10 to 2016–17. Most of the target populations show a decreasing rate of seclusion events from 2009–10 to 2016–17; General (15.4 to 8.0), Child and adolescent (11.4 to 11.1), Older person (3.2 to 0.6), & mixed (13.3 to 10.0; data up to 2012–13 only). Forensic increased over the same period (12.0 to 14.7). Refer to Table RP.3. Back to figure RP.4

Figure RP.5

Horizontal bar chart showing the rate of seclusion events in public sector acute mental health hospital services by hospital excluding forensic units in 2016–17, ordered from highest to lowest. The highest seclusion rate is 56.0 seclusion events per 1,000 bed days. Several hospitals had a seclusion rate of 0 recorded. Refer to Table RP.7. Back to figure RP.5

Figure RP.6

Bar chart showing the rate of mechanical and physical restraint events in public sector acute mental health hospital services in each state and territory for 2016–17. NSW 0.5 mechanical & 8.9 physical, Vic 2.0 mechanical &17.8 physical, Qld 0.0 mechanical & does not collect physical, WA 0.0 mechanical & 4.5 physical, SA 3.6 mechanical & 2.5 physical, Tas 0.1 mechanical & 10.4 physical, ACT 0.2 mechanical & 5.5 physical, NT 9.2 physical & 0.0 mechanical. Refer to Table RP.5. Back to figure RP.6

Figure RP.7

Bar chart showing the rate of mechanical and physical restraint events in public sector acute mental health hospital services by target population in 2016–17. General mechanical 0.4 & physical 4.7, Child & adolescent 0.4 mechanical & 11.4 physical, Older person 2.6 mechanical & 3.3 physical, Forensic 4.8 mechanical & 89.0 physical. Refer to Table RP.6. Back to figure RP.7

Figure RP.8

Horizontal bar chart showing the rate of physical restraint events in public sector acute mental health hospital services by hospital excluding forensic units in 2016–17, ordered from highest to lowest. The highest rate is 37.9 physical restraint events per 1,000 bed days. Several hospitals had a rate of 0 physical restraint events recorded. Refer to Table RP.7.Back to figure RP.8

Figure RP.9

Horizontal bar chart showing the rate of mechanical restraint events in public sector acute mental health hospital services by hospital excluding forensic units in 2016–17, ordered from highest to lowest. The highest rate is 19.7 mechanical restraint events per 1,000 bed days. Several hospitals had a rate of 0 mechanical restraint events recorded. Refer to Table RP.7. Back to figure RP.9