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 (for example, using devices such as belts, or straps); and, Physical restraint (for example, the application by health care staff of hands-on immobilisation techniques). Unspecified restraint, that is, the type of restraint is unknown, has been removed from 2016–17 onwards. Data on Physical restraint is available for Queensland for the first time for 2017–18.

States and territories have different policy and legislative requirements regarding restraint practices and have therefore had different processes and systems in place for collecting data, and differences in the types of restraint which 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 section has further information about data quality.

In 2017–18, there were 16,917 Physical restraint events nationally, which represents 10.3  Physical restraint events per 1,000 bed days; while Mechanical restraint was less common (796 events, representing 0.5 events per 1,000 bed days) (Figure RP.6). Victoria had the highest rate of Physical restraint events (22.0 events per 1,000 bed days) and Mechanical restraint events (1.4 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.

 

Figure RP.6 Alternative text - Source data: Restrictive practices tables (522KB 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 2017–18, the Physical restraint rate for Forensic services (107.2 events per 1,000 bed days) was over 4 times the rate for Child and adolescent services (22.5) and over 17 times the rate for General services (6.3). The rate of Mechanical restraint was also highest in Forensic services (Figure RP.7). From 2015–16 to 2017–18, the use of restraint (both Physical and Mechanical) was more common in Forensic services than other service types.

 

Figure RP.7 Alternative text -Source data: Restrictive practices tables (522KB 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 2017–18. 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.