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 was not reported by Queensland for all data periods.

States and territories have different policy and legislative requirements regarding restraint and have therefore had different processes and systems 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 in May 2017. It is expected that data quality will improve over time as systems 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.

Nationally, there were 13,321 Physical restraint events in 2016–17, which represents 8.3 Physical restraint events per 1,000 beds days; Mechanical restraint was less common (1,479 events, representing 0.9 events per 1,000 bed days) (Figure RP.6). Of the states reporting data, Victoria had the highest rate of Physical restraint events (17.8 events per 1,000 bed days). This is may be the result of higher acuity admission thresholds due to lower per capita bed numbers inflating the results on a per bed day basis. South Australia had the highest rate of Mechanical restraint events (3.6 events per 1,000 bed days).

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Figure RP.6 Alternative text - Source data: Restrictive practices tables 2016-17 (613KB XLS).

Note: 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.

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 2016–17, the Physical restraint rate for Forensic services (89.0 events per 1,000 beds days) was over 7 times the rate for Child and adolescent services (11.4) and over 18 times the rate for General services (4.7). The rate of Mechanical restraint was also highest in Forensic services (Figure RP.7). In 2015–16 and 2016–17, the use of restraint (both Physical and Mechanical) was more common in Forensic services than other service types.

 

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Figure RP.7 Alternative text -Source data: Restrictive practices tables 2016-17 (613KB XLS).

Hospital level

Hospital level data is available for the first time in this release for selected metrics. 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 2016–17. Note that data includes public sector acute mental health hospital services only and excludes forensic units. At the time of writing Victoria advised that ‘The Victorian Government is currently in Caretaker period and will not be providing data at this time’. The variability in restraint events between hospitals may be due to a range of factors, such as service delivery models, the number of acute mental health service units in the hospital, the patient case mix, and the target population of the service.

 

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