Restraint

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. Unspecified restraint was reported for 2015–16 to represent combined restraint or when data providers were unable to disaggregate mechanical and physical restraint events. Data on physical restraint in Queensland is available from 2017–18.

States and territories have different policy and legislative requirements regarding restraint practices and therefore different systems in place for collecting data, and differences in the types of restraint that are reported. In addition, the reporting of restraint data is still a novel exercise, with the first release of data occurring in May 2017. It is expected that data quality will improve over time as information systems are refined and definitions are better understood by the sector. As such, caution should be exercised when interpreting this data and comparing results between states and territories and over time. The data source has further information about data quality.

In 2018–19, there were 18,690 physical restraint events nationally, which represents 11.3 physical restraint events per 1,000 bed days; mechanical restraint was less common (991 events, representing 0.6 events per 1,000 bed days) (Figure RP.6). Victoria had the highest rate of physical restraint events (24.1 events per 1,000 bed days) and mechanical restraint events (1.3 events per 1,000 bed days). This may be the result of Victoria's service delivery model producing a higher threshold for acute admission and inflating restraint metrics compared to other jurisdictions. 

 
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Description of figure RP.6 - Source data: Restrictive practices tables (660KB XLS).

Notes: Victoria's service delivery model produces a higher threshold for acute admission and the seclusion and restraint metrics may be inflated compared to other jurisdictions. Victoria uses a specific methodology to derive the total number of restraint events. Queensland's Mental Health Act 2016 came into effect in March 2017. For the 2017–18 collection, Physical restraint events were recorded for the first time. However, as a new collection, caution is required when interpreting comparisons over time as these may be reflecting differences in business processes for recording data rather than a true variation in the use of physical restraint.

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 2018–19, the physical restraint rate for Forensic services (105.8 events per 1,000 bed days) was nearly 4 times the rate for Child and adolescent services (27.2) and over 14 times the rate for General services (7.3). The rate of mechanical restraint was also highest in Forensic services (Figure RP.7). From 2015–16 to 2018–19, the use of physical and mechanical restraint was more common in Forensic services than other service types.

 
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Description of figure RP.7 - Source data: Restrictive practices tables (660KB XLS).

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 2018–19. 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, such as 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 also interpreted with caution as small changes in the number of restraint events can have a marked impact on their overall rate.

 
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