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Reducing Restrictive Practices

The Commission supports working towards the elimination of seclusion and restraint in all mental health services.

There is strong agreement that seclusion and restraint is a human rights issue, that it has no therapeutic value, that it has resulted in emotional and physical harm for consumers and staff, and that it can be a sign of a system under stress. In addition, there is a lack of evidence internationally to support seclusion and restraint use in mental health services.

The NMHC acknowledges that this is a multifaceted issue and that work is underway around Australia to understand and address the factors that lead towards seclusion and restraint, to monitor its use and increase transparency and accountability for the public. The NMHC urges all governments to support the commitment made in 2005 to reduce and, where possible, eliminate the use of seclusion and restraint.

Safe in Care, Safe at Work

The National Mental Health Commission (NMHC) engaged the Australian College of Mental Health Nurses (ACMHN) to undertake work aimed at reducing restrictive practices and ensuring both safety in care and safety for staff in Australian mental health services.

The project extends previous work undertaken by the ACMHN in the 2017 NMHC funded project, Supporting Mental Health Nurses towards cultural and clinical change: Facilitating ongoing reduction in seclusion and restraint in inpatient mental health settings in Australia. The project reflects a recognition of the importance of safety in care and at work and is a response to an ongoing dialogue with key stakeholders, including mental health nurses, consumers, carers and industry.

The project includes a package of documents comprised of:

  • an audit toolkit for services
  • the Australian adaption of the Six Core Strategies checklist
  • and a list of guiding documents to reduce seclusion and restraint.

An abridged version for mental health staff and managers was developed that emphasises the use of the checklist to guide the reduction of seclusion and restraint. Please find both documents available for download below.

For more information, please read the ACMHN's media release and visit the ACMHN website.

Definitions for mechanical and physical restraint in mental health services 

The National Mental Health Commission commends the Australian Health Ministers’ Advisory Council for endorsing national definitions for mechanical and physical restraint in mental health services.

The key principles define restrictive practices as a last resort, while the dignity and rights of people accessing mental health services should be respected and supported at all times.

Reducing, and where possible eliminating, restrictive practices in mental health services has been a key national mental health safety and quality priority.

The national principles aim to establish a consistent best practice approach to support the goal of eliminating the use of mechanical and physical restraint by mental health services.

It is envisaged the principles will guide and support the development and review of detailed jurisdictional operational guidelines as appropriate across a range of service settings. The principles are intended to apply to all mental health services in Australia.

The Commission also endorses the document which outlines the national principles for communicating about restrictive practices with consumers and carers.

National Seclusion and Restraint Project

In 2005, all Australian Governments agreed to act to reduce and where possible to eliminate the use of seclusion and restraint of people with mental health issues. Despite this, through our consultations, seclusion and restraint have consistently been raised as issues that people want something done about. They are raised by people with lived experience of mental health issues and their families, as well as service providers and policy makers.

The Commission is committed to best practice in reducing and eliminating the seclusion and restraint of people with mental health issues and to help identify good practice approaches. 

The National Mental Health Commission released a position paper on seclusion and restraint in 2015, based on commissioned research.

How you can get involved

In 2013 we launched the Seclusion and Restraint Declaration to encourage people to show their support for reducing and eliminating seclusion and restraint. We were encouraged by the response from individuals and organisations that have signed the Declaration and committed to being part of driving change. 

  • Display your Declaration around your home or office.
  • Show your support via social media. 
  • Discuss the issues with friends, family and colleagues and encourage them to sign the Declaration. 

National Seclusion and Restraint Survey 

The survey is now closed. More than 1000 responses were received from the survey. Data collected from the survey will be used alongside focus groups and the direct input of people with lived experience, their families, friends and supporters as well as service providers, workforce interest groups and first responders. 

The results of this research will have important implications for policy development and will better inform the debate surrounding the use of seclusion and restraint. The Commission thanks everyone who told their story.

Core Reference Group (CRG)

In 2013, the Commission formed a Core Reference Group (CRG) to oversee this work. The CRG is currently chaired by Mr Bradley Foxlewin and Prof Chris Ryan, and we thank Kath Thorburn for her previous co-chairing of the Group. 

Members of the CRG include people with lived experience and their families, clinicians and people working in services, as well as human rights, legal and disability advocates.