Reducing Restrictive Interventions

This paper discusses the Mental Health Act (MHA) of 2014 and how it informs the regulation of the use of restrictive interventions. The paper highlights the various provisions that MHA has put in its push to promote reductive restrictive interventions. It also discusses the core features of the MHA, restrictive interventions, bodily restraint, seclusion, authorization to use restrictive interventions, and the Victorian framework for reducing restrictive interventions.

Running head: Reducing Restrictive Interventions
Reducing Restrictive Interventions
Author Name(s)
Institutional Affiliation(s)
Author Note

Reducing Restrictive Interventions 1
Abstract
The objective of this paper is to discuss how MHA (2014) and a recovery framework informs the
regulation of the use of restrictive interventions restrictive interventions. The law requires that
therapeutic environments to refrain from procedures of restrictive practices while focusing on the
patients’ recovery. If restrictive interventions have to be used, they should always come as they
last result. The restrictive interventions not only cause physical harm, but they also cause patients
and their carers unnecessary psychological trauma. This paper would be discussing the various
provisions that MHA has put in its push to promote reductive restrictive interventions.
Keywords: Restrictive Interventions, Human Rights, Seclusion, Bodily Restraints

Reducing Restrictive Interventions 2
Reducing Restrictive Interventions
The Mental Health Act (MHA) was effected on 1st July 2014 in Victoria. This act was
promulgated by the Victoria Government to protect the rights, freedom, dignity, and integrity of
people suffering from mental illnesses. This Act not only protects the rights of mental health
patients, but it also grants them the right to make medical decisions that affects their mental
(Parliament of Victoria, 2014). Further, this Act encourages communication between doctors and
consumers. Along with the responsibility of informing the patients about their illness, the doctors
will also need to inform the family members and caregivers about the patients care plan (N. H. S.
Confederation, 2018). Before the Act came into place, these responsibilities were not legally
required of the practitioners and they could provide them upon their discretion.
Core Features of the MHA
The MHA encourages the consumers of mental health services to participate in decision
making processes regarding their treatment, diagnoses, and recovery. Also, this act recognizes
that mental consumers are people who have rights, and their integrity, dignity and human rights
deserves respect and protection. It prevents corrupt practitioners from exploiting the patients.
The acts put some more priority to minors suffering from mental illnesses. The importance of
children’s safety, care and well-being is placed at the fore-front.
The doctors have the responsibility of providing educating and information to the
consumers. A very fundamental provision is the emphasis on the importance of treatment and
recovery procedures provided to the patients. The act stress that such services must ensure that
no rights of the patient that are breached. The care and treatment provided to the patients are to
be provided in a holistic approach focusing on recovery and must be individualized for every
patient. A general approach should not be taken in the treatment for every patient.

Reducing Restrictive Interventions 3
From the past studies, some of these features have been found to be very important in the
in concern for mental health services. For instance, the study of (Chan, Webber, & Hayward,
2013) analyzed the use of restrictive interventions on minors and young adults. The results of
this study found that there is a great number of children who are subjected to restrictive
interventions. Another study conducted by (Brady, Spittal, Brophy, & Harvey, 2017) to weigh the
overall perception of the benefits of restrictive interventions among consumers. Despite the fact
that there were a few reported benefits, very few patients love the experience. This study was
part of the literatures that find no rationale in the use of restrictive interventions.
In the study of (Webber, McVilly, & Chan, 2011), restrictive interventions were being
used as a strategy instead of a last resort. The interest of these authors for this study was inspired
by their previous study that had shown that the use of restrictive interventions was very common
(Webber, McVilly, Stevenson, & Chan, 2010). The authors undertook a study to confirm the
perceived serious harm as the reason for the prevalence rates of cases in restrictive intervention.
However, the conclusion of this study was that restrictive interventions were being used as health
intervention strategy.
Above all these reasons that demonstrates the best interest of MHA, the work of
(McSherry, 2017) emphasize on the Convention on the Rights of Persons with Disabilities
(CRPD). In article 3, the work of (McSherry, 2017) clarifies the issue of respect for individuals’
autonomy and inherent dignity and individual as explained in CRPD.
Restrictive Interventions
Restrictive interventions are regulated in part 6 of the MHA. With respect to mental
health, restrictive interventions are certain medical procedures that limit or restrict a patient
suffering from mental illness some rights such as the freedom of movement, speech, etc.

Reducing Restrictive Interventions 4
Restrictive interventions could include other factors such as seclusion and isolation of the person,
physical and mental restrains for the sake of treatment and recovery procedures (Tang, Liu,
Zhang, & Zhang, 2018). In section 105, the law provide that restrictive interventions can only be
used if all reasonable less restrictive methods fail.
Bodily Restraint
Division 3 in part 6 of the act provides regulates issues of physical restraint. This is the
use ofe physical or mechanical contact with a person in order to restrict their movement partially
or completely. Section 113 of the Act provide that body restrain may be necessary where it would
help in preventing harm to the patient or a different person. It can also be used for the purpose of
administering treatment to the patient (Tang et al., 2018).
Seclusion
Division 2 of part 6 regulates the practice of seclusion in mental health services.
According to (Mayers, Keet, Winkler, & Flisher, 2010), seclusion includes confinement or
isolation of a patient in a supervised and secure manner in order to prevent the patient from
harming others due to the mental illness they are suffering from. The provisions of section 110
provides that a mental health patient may be put to seclusion to prevent harm for him or other
persons. However, section 111 deals with regulation of seclusion. Firstly, it decides the person
who can authorize seclusion if it comes out of necessity that such patient would be secluded. The
section provides that either an authorized psychiatrist or a registered medical professional or
senior registered nurses in the case where an authorized psychiatrist is not available.
Sub-section (2) deals with situations where seclusion is authorized by registered medical
practitioners or the senior registered nurse. This subsection requires that if any of these officers
authorizes seclusion, they must notify the authorized psychiatrist who was not present to

Reducing Restrictive Interventions 5
authorize seclusion. When subsection (2) is satisfied, then the authorized psychiatrist has a duty
to examine the patient who was put to seclusion and determine whether the person would remain
in seclusion or terminate it.
Further, subsection (4) deals with situations where an authorized psychiatrist can be
absent to both authorize seclusion and examine it to very its necessity. In this section, the duty to
determine the longevity of seclusion is put under the medical officer or the senior registered
nurse. the authorized psychiatrist must ensure that a registered medical practitioner examines the
person and determines whether the continued use of seclusion of the person is necessary as soon
as practicable after the authorized psychiatrist is notified under subsection.
Section 112 deals with the care of the secluded person. This section directs medical
professionals to clinically monitor patients put to seclusion. Monitoring should not be not take
intervals that go beyond 15 minutes. Further, the authorised psychiatrist is designated to examine
the secluded patient a until that psychiatrist is satisfied that the seclusion is necessary. The
examination should not take intervals more than four hours.
Authorization to Use Restrictive Interventions
Section 15 provides the guidelines when practitioners can use physical or bodily restraint
without the need to seek authorization. Section 115 (b) provides that unauthorized restrictive
interventions if professionals charged with giving authority are not available yet restrictive
interventions is necessary at the moment. However, the same section under (3) requires the stop
of the use of restrictive interventions if a senior officer charged with authorization finds it
restrictive interventions unnecessary.
Under section 115(1a) the law allows registered nurses to use unauthorized bodily
restraint when there is an urgency and the failure to use restrictive interventions would result to

Reducing Restrictive Interventions 6
serious harm to either the patient or another person. Restrictive interventions are to be used on
persons or patients suffering from mental illness for the sole purpose of treating and recovering
them. They are not to be used for purposes such as sadistic entertainment, torture, information
extraction, etc. The work of (Bowers et al., 2015) provides a conclusion that the use of restrictive
interventions must be authorized by professionals, experts or institutions.
The persons responsible for authorizing the use of restrictive interventions can be: 1) a
psychiatrist, who is authorized by the government or an organization to provide such an
authorization, 2) A senior doctor or medical practitioner can also provide such an authorization in
times of extreme emergency or if the authorized psychiatrist is unavailable at the time(Angell &
Bolden, 2015). If a medical practitioner has provided the authorization, the authorized
psychiatrist must be notified of this decision as soon as he or she is available. Once the
psychiatrist is notified, it then becomes his or her responsibility to check the patient in order to
decide the continuation of restrictive interventions or to stop them (Riding, 2016).
Reduction of Restrictive Interventions underpinned by The MHA of 2014
The Victorian Government has done extensive research on the use of restrictive
interventions in mental health illness cases and has decided to bring forward the MHA in 2014
(Fletcher et al., 2017). The guidelines states that a mental health institution must only use
restrictive interventions as a last resort and only when all other measures taken have failed.
Restrictive interventions must in no way be a regular way of treating patients and must only be
done in cases where there is no other option. The staff treating the mental health patients must
observe the dignity of the patient. The staff treating the mental health patient must observe the
rights of the patient. The staff must meet the legislative requirements.

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Initiative to Reduce Restrictive Interventions
In the state of Victoria, the types of restrictive interventions used are seclusion and
physical restraint. There are various steps that have been taken to reduce restrictive intervention
as guided by the MHA of 2014. The work of (McKenna, 2016) informs on various alternatives to
restrictive interventions. The work names systemic service-based approaches six essential
strategies. However, all these strategies stretch on the improvement of the leadership
management to bring organization change. For instance, the work of (McKenna, 2016) advices
on the use of data for informing the practice, a focus on the development of the workforce, use of
trauma informed intervention and sensory modulation employment of the expertise who are
specialist of lived experience in mental health and illnesses to work together with clinical staffs,
and the use of debriefing techniques. These Victorian government has also proposed for the
implementation of the initiatives. These plans that have been developed by medical institutions
and help centers include numerous strategies to be implemented in order to successfully reduce
the use of restrictive interventions across the state (Victoria Government, 2015).
Safewards
Safewards is a medical model used to reduce restrictive interventions in many medical
institutions around the world. The state of Victoria, Australia has successfully implemented this
model throughout the state in an effort to reduce or completely eliminate the use of restrictive
interventions (Cope Foundation, 2011). In an effort to prove the efficacy of Safewards, the study
of (Fletcher et al., 2017) found that Safewards interventions were appropriate for use in mental
health services and it is best option compared to seclusion. Also, the work of (Glasper, 2014)
states that the implementation of Safewards has been successful in reducing the use of restrictive
interventions

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Victorian Framework for Reducing Restrictive Interventions
The Victorian Government, along with the establishment of the MHA, has developed a
framework to reduce the use of restrictive interventions. According to (Health Vic, 2013), the
framework provide a safe environment where mental health patients can receive mental health
help and it also helps the mental health professionals in planning and designing services for
better reduction and where possible achieve complete elimination of the use restrictive
interventions.
According to (Health Vic, 2013), the practice of reducing restrictive i.e restraints and
seclusions, are essential in providing mental health assistances that are generally safe to all
patients, visitors, carers, health professional. The framework advices that restraints and
seclusions cannot be used as the main focus on mental health. In agreement with this framework,
the work of (Vollmer, et al., 2011) states that all possible measures and options of controlling or
calming the patient should be taken before engaging any restrictive interventions to be used.
According to (Health Vic, 2013), there is evidence that has shown that restrictive interventions
can retraumatize consumers as part of the past experiences of traumatization, and such can
impede the proper development a trusting professional-patient relationships.
According to (Department of Health, 2013), the framework principles aims to provide a
safe environment for all, and this environment was underpinned by wide-range of reviews of
restrictive interventions research. The report states that the framework encompass three core
principles which are derived from the believe that recovery is all about empowering people to
formulate their own decisions and their involvement in self-care. Therefore, the aim of restrictive
intervention is to create a collaborative environment. Secondly, the framework recognizes that
restrictive intervention particularly seclusion and restraints put the rights, freedom, physical and

Reducing Restrictive Interventions 9
psychological safety of a person in jeopardy. Lastly, the board has to manage and monitor the use
of restrictive intervention.
The three principles in the framework advice that the reducing restrictive interventions
should be everyone’s business where all he key stakeholders (people with lived experiences,
carers, service staff) should take their roles in providing, designing, and implementation a safe
environment. It also advices on the need for respect and dignity for the people with lived
experiences together with their carers and staff. This principle is explained in detail in the work
of (Clark, Shurmer, Kowara, & Nnatu, 2017) where the respect for the should not be ignored due
to their behaviors caused by the mental state. Further, the organization of the service
environment should be made to ensure that safety it promotes safety and wellbeing for everyone
involved. The management of difficult and challenging behaviors should feature acts of
humanity, decency, and respect. In overall, the principles are explained as encompassing
capability, care approach and enablers.
The principle of capabilities of services refers to how mental health services should focus
their capabilities in reducing restrictive practices (Department of Health, 2013). This principle
focuses on four main areas. The first one is on mental health leadership and accountabilities. In
this area, the principle emphasizes on setting targets for the develop methods. These methods
should be aimed at facilitation of maximum accountability and changes in the practices. The next
area that this principle looks at is the mental health systems where it emphasizes on the support
for the delivery of actionable plans, clarity of the health service’s in their vision in the
implementation of the reducing restrictive interventions. The principle also emphasizes on the
developments that support the consumer’s self-determination. i.e, respect for person’s rights,

Reducing Restrictive Interventions 10
wishes and plans for the recovery. Lastly, this principle emphasizes on the copiability of the
workforce in executing the roles for clarity, understanding and the application of practices.
The second principle is summarized under care approaches (Department of Health,
2013). The framework recognizes that approaches to quality care are integral to the health
organizational capabilities. The framework advices for a focus on three main care approaches.
One of these is the recovery-oriented approach. According to the A recovery approach should
focus on promoting the consumer’s choice, agency and independency of the management.
Recovery approaches should encourage the consumer’s self-management and self-determination
in matters of mental health. They should also be tailored, strengths-based and personalized
towards unique needs, circumstances, and preferences. In overall, they are holistic approach
aimed at empowering the individual.
The last principle emphasizes on the enablers (Department of Health, 2013). The
framework recognizes four enablers in the organizations effort in reducing restrictive
interventions. The first one is a focus on cultural system where the organization culture and
systems should be aligned towards its objective in reducing restrictive interventions. The second
enabler emphasizes on provision of a healthy environment where the physical settings, social
dynamics, culture, and behavioral patterns demonstrate an environment that is calm, safety of the
wards, and therapeutic safety. The third enabler is the anticipation of needs and management of
escalations. This one emphasizes on professional support for patients and the identification and
timely response to anxiety, conflicts and acute arousals. The fourth enabler emphasize on the
evaluation and quality assurances which are focused on the improvement of the services in
reduction of restrictive interventions.

Reducing Restrictive Interventions 11
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