Mental health services in Australia

Restraint is defined as the restriction of an individual’s freedom of movement by physical or mechanical means. Data for two forms of restraint are specified by the Mental health Seclusion and Restraint National Best Endeavours Data Set (SECREST NBEDS): mechanical restraint uses devices on a person’s body to restrict their movement (for example, belts or straps); and physical restraint uses the application by health care staff of hands-on immobilisation techniques.

Restraint data are available for each year from 2015–16. In 2019–20, there were 18,352 physical restraint events nationally, representing 11.0 physical restraint events per 1,000 bed days; there were 1,213 mechanical restraint events, representing 0.7 events per 1,000 bed days) (Figure RP.6). Victoria had the highest rate of physical restraint events (19.2 events per 1,000 bed days) and mechanical restraint events (1.3 events per 1,000 bed days).

Source data: Restrictive practices 2019–20 tables (689KB XLS).

Target population

Restraint data can also be presented by the target population of the acute specialised mental health hospital service where the restraint event occurred. In 2019–20, the physical restraint rate for Forensic services (69.3 events per 1,000 bed days) was more than 2 times the rate for Child and adolescent services (30.7) and almost 9 times the rate for General services (7.9). The rate of mechanical restraint was also highest in Forensic services (Figure RP.7). For the time period 2015–16 to 2019–20, the use of physical and mechanical restraint was more common in Forensic services than other service types.

Source data: Restrictive practices 2019–20 tables (689KB XLS).

Remoteness

Due to the small number of hospitals located in Outer regional and Remote areas, for the purpose of remoteness analysis these categories have been combined. There were no hospitals in the restraint dataset located in Very Remote areas.

In 2019–20, hospitals located in Major cities had a physical restraint rate of 11.7 events per 1,000 bed days, and a mechanical restraint rate of 0.8. This rate was higher than for Inner regional facilities (7.6 physical restraint events per 1,000 bed days; 0.4 mechanical restraint events per 1,000 bed days) and Outer regional and Remote area facilities (10.0 physical restraint events per 1,000 bed days; 0.3 mechanical restraint events per 1,000 bed days).

Hospital level

Figure RP.8 shows the variation in the physical restraint rate and Figure RP.9 shows variation in the mechanical restraint rate across Australia in 2019–20. Note that data includes public sector acute mental health hospital services only and excludes forensic units. The variability in restraint events between hospitals may be due to a range of factors, including the hospital’s service delivery model, the number of acute mental health service units in the hospital, the patient case mix, and the target population of the service units. High numbers of restraint events for a few individuals can also have a disproportional effect on the rate of restraint reported. Data for individual hospitals should be interpreted with caution as small changes in the number of restraint events can have a marked impact on their overall rate.

Source data: Restrictive practices 2019–20 tables (689KB XLS).

Source data: Restrictive practices 2019–20 tables (689KB XLS).