Restrictive Practice in Australian Mental Health services

Running head: MENTAL HEALTH NURSING
Mental health- nursing
Name of the Student
Name of the university
Author’s note

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Assignment topic 2: Restrictive practice in Australian mental health services
Introduction
Restrictive practices can be defined as any sort of practices that poses effect on the
restricting the freedom of movement of a person suffering from disability. Previously, a wide
range of restrictive practice was in vogue in the name of treatment in mental health. Considering
the wide number of disadvantages of the various restrictive services used, the use of such
practices has been banned or restricted (Allan et al., 2017).
This paper will describe about the impact of seclusion to the consumers and the health
care providers. Furthermore, it will discuss about the roles of the registered nurse in
collaborating with the consumers to work towards the State/National territory initiative in
reducing cases of seclusion and restraints.
Effect of seclusion on the consumers and health care professionals
The restrictive practices that are in vogue in Australia includes restraints (chemical,
mechanical, physical and social) and seclusion. Individual having disability and displaying
challenging behaviour might be subjected to restraining practices in various contexts that
included- supported living in the group homes, residential aged care facilities, mental health
facilities, prisons, hospitals and schools.

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Seclusion can be referred to as a tool that is normally used by the psychiatrists for
managing the aggressive and the disruptive behaviour of the mental health patients. Coercion and
seclusion overrides the will of an individual and hence raises the ethical questions. These
measure limits several fundamental rights like the liberty of choice or movement, independence
and physical integrity (Chieze, Hurst, Kaiser & Sentissi, 2019). According to Allan et al., (2017),
some of the emotions expected during seclusion incudes disempowerment, fear of confined and
claustrophobic places and not having any idea when the seclusion will end, or anger related to
the physical interventions following process of seclusion and an ongoing sense of
defencelessness. Some of the other feelings associated with seclusion involves loneliness, loss of
autonomy, powerlessness and humiliation (Muir‐Cochrane, O'Kane & Oster, 2018). In order to
continue with a treatment, it is necessary to develop a therapeutic relationship between the client
and the therapist. Seclusion restricts the development of therapeutic relationship between the
patient and the clinician. Individuals under seclusion experience feelings of fear, sadness, anger,
shame, abandonment (Norvoll, Ruud & Hynnekleiv, 2015). Seclusion in patients can cause
severe psychological distress in the patients. As per the researches, patients having past
experiences of trauma are more likely to be secluded, like physically taking them in to a locked
and isolated room. It has been found out in a study that the people kept in seclusion are more
likely to suffer from post-traumatic disorder, disturbed by the experience in seclusion (Fletcher et
al., 2017). In a study conducted by Larue et al., (2016), with 50 participants, it has been found
that the number of participants who had been asked to fill a questionnaire had experienced
restraint for atleast once in their course of treatment. They have mentioned about the feelings of
anger, frustration while in seclusion. One such participants had also developed suicidal ideation.

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The consumers of the mental health service have strongly protested against about the
harm of seclusion and various other forms of request. The families and the consumers have also
raised strong voice of protest about the disadvantages of seclusion and all the forms of restraints
Brophy et al., 2016). Consumers and the families, friends and the various supporters have also
raised concerns with the “emotional restraints” whereby, the clients feel forced from expressing
their views in an open manner and fairly to the staffs for fear of the consequences. It has been
noticed in a recent reviews that patient reported feelings of the vulnerable helplessness and
traumatised by the experience (Brophy et al., 2016). As per the perceptions of the health care
professionals, seclusion is just a stimulus limiting and protective way towards the patients and is
normally applied to the patients posing a high risk of injury to the staffs and the other patients
and it can be considered as an emergency situation. While the professionals and te therapists
have admitted about the ill effects of seclusion, but have also stated that these are only applied in
extreme cases and is generally integrated as a part of the milieu therapy along with the presence
of the staffs (Haugom, Ruud & Hynnekleiv, 2019). Seclusion and isolation can be referred to as
an issue related to social justice, as patients tends to feel powerless, when in seclusion and
powerlessness is an injustice. It can also be termed as dehumanizing. According to (Kinner et al.,
2017) the concept of seclusion is also inconsistent with the concept of personal recovery. In the
study, when the participants were enquired whether they find it important and feasible to
eliminate seclusion. The large number of respondents have believed that it is both needed and
possible to remove the emotional and the mechanical restraints (Norvoll, Ruud & Hynnekleiv
2015). In comparison, to the professionals both the carers and the consumers are more likely to
believe that the elimination of the physical restraint was desirable and possible. The medical
model of mental health is treats mental disorder like any other physical illness. Hence, the mode

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of the applied treatment is often harsh and requires restraints and seclusion, without considering
the psychological effect of seclusion (Bowers et al., 2017). The professionals treating patients
with mental illness often use seclusion restraints in case of risky situations and as the last resort.
According to the General Regulations of the Mental Health Care Act No 17 of 2002, it is
necessary to ensure, that whenever, seclusion and restraints are used, appropriate methods needs
to be followed for preventing abuse, injury and every patent should be treated with respect and
their liberties should not be infringed upon.
Contrary to this, in a study by Khalil, Al Ghamdi and Al Malki (2017), a minority of
people have reported positive views about seclusion, as it helps them with the opportunity of
meditation, or that seclusion have had a calming effect on them. In a Canadian study, the patients
have reported on the comfort and safety of the seclusion rooms and the mindfulness that they
achieve and meeting of the physical needs of the patients. There are very few evidences which
shows that seclusion and isolation have reduced the stress, depression and pain. Furthermore, it
cannot be denied that it is necessary for patients who are aggressive and violent and be a threat
for the other patients. A study conducted by Ezeobele et al., (2014) on the other hand have
suggested that the patients in seclusion are often ill-treated by the health care staffs, hence in
most of the cases, that they develop resentment towards the staffs, while many have admitted
that they get time for meditation.
Role of the registered nurse in collaborating with the consumers
Restrictive practices are continued to be used in psychiatry despite of the increasing cases
of harm and international efforts to lessen and cease the use. A number of programs has been
incorporated throughout the nation, demonstrating achievement in cutting down the rates as well

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as the duration of seclusion. The mental health registered nurses have an important role in
providing mental health services and often characterize the staffs that are more likely to use
seclusion and the restraints (Hernandez et al.,2017) . Since, the nurses work as the frontline
health care workers alongside with the patients. It is necessary to know about their perception
about the application of the restraint and seclusion. Person-centred practice can be described as
the main tenet of the practice of nursing. Some of essential aspect of person centred practice
involves development of the rapport, focusing on the need of the person, partnership, being
compassionate and empathetic and respectful. Restrictive practices can be seen as conflicting to
the principle of the person –centred care and a patient is not at the centre of care when they are
getting secluded (Muir‐Cochrane et al., 2018). Nurses need to believe that restraints and
seclusion should be kept as the last resort or when it is for the safety of the patient. Nurses should
escalate the matter, if they witness any such cases of unnecessary seclusion and restraints on any
person with mental illness. They need to follow empathetic measures while dealing with elderly
patients in the geriatric wards (Mallari & Tariman, 2016). Nurses often faces with ethical
dilemma while deciding on restraints provided to the elderly dementia patients. They should
withhold the ethical principles of autonomy for the mental health patients under seclusion.
(Riahi, Thomson & Duxbury, 2016). Restraint and seclusion directly breaches the ethical
principles of autonomy. The registered nurses often advocate for the mental health patients are
not in condition to participate in the decision making process. A nurse’s knowledge and skills are
important forces that can help to influence the patient care in an ethical manner. For this, the
nurses needs to have knowledge about the ethical principles and models. Using ethical principles
the registered nurses arrive at a solution, in an atmosphere of caring, respect, openness and
honesty. According to the NMBA standard 2 of the nursing, registered nurses should advocate on

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behalf of people in a manner which respect the autonomy and legal capacity (NMBA, 2018).
While caring for patients with mental health disorder, it is necessary to be respectful to the
dignity, values, culture, beliefs and rights of the patients. Also, it has been stated in one of the
standards that registered nurses are responsible for reporting any ill conduct of the health care
professionals and the other health care workers (NMBA, 2018). Hence, registered nurses should
bring any incidences of restraint or torture under the notice of the authorities.
As per the Mental Health Act 2007, section 68, patients with mental disorder should get
the best available care and treatment in an environment that is conducive and least restrictive. A
timely diagnosis is needed and registered nurses should assess patients to report any possible
signs of deterioration. Nurses should see that no restriction is provided to the freedom of the
patients and other people with mental illness. It should also be noted that their dignity, rights and
self –respect needs to be kept (NSW Government, (2007).Although section 190 of the Mental
Health act 2007 states that any personnel under is not restricted to take necessary actions, if he
/she feels to take anybody under restraints for the sake of preventing serious physical injury and
harm to the patient himself or the community (NSW Government, 2007). Again, patients who
had been under seclusion for a long time would be provided with proper rehabilitation services
and psychological services. The nurse leaders should educate the mental health care workers to
restrict the use of restraints without the approval of doctors. Moreover, the mental health patients
should be treated holistically for healing their mind, body and soul.
Conclusion
It can be stated that seclusion and the restraints should always be used as the last resort
when all the other alternatives have been tried. This is due to the fact, that both the consumers

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and the carer consider it to be a poor practice and immensely affects the psychological wellbeing
of a person, including humility, anxiety, aggression, triggered trauma, shame and more.
Hence, literature and doctors have stated that he interventions needs to be used in
conjunction with the evidence based treatment in limiting the progression of the disruptive
behaviour, which would ultimately contribute to positive clinical outcomes in the treatment of
the mental health care users.

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