Reducing Restrictive Practices in Australian Mental Health Services

This report delves into the ongoing efforts to reduce restrictive practices, such as seclusion and restraint, within Australian mental health services. It examines the historical context, the current state of these practices, and the perspectives of both consumers and healthcare professionals. The report highlights the negative impacts of restrictive practices, including trauma and dehumanization, while also acknowledging their perceived benefits in ensuring safety. It explores various initiatives, policies, and models, such as the Safewards model and the WHO's Quality Rights initiatives, aimed at reducing and eliminating these practices. The role of registered nurses in implementing these changes, including the use of trauma-informed care and collaboration with consumers, is also discussed. The report concludes by emphasizing the need for a multi-faceted approach that addresses barriers to elimination, promotes alternative strategies, and prioritizes both consumer safety and the well-being of healthcare professionals. It underscores the importance of ongoing research, staff training, and empathic relationships to achieve meaningful reductions in restrictive practices. The report is a valuable resource for students seeking to understand the complexities of mental health care in Australia.

Running head: MENTAL HEALTH 1
Mental health
Name
Institutional Affiliation

MENTAL HEALTH 2
RESTRICTIVE PRACTICES REDUCTION OF SERVICES FOR MENTAL HEALTH
IN AUSTRALIA
In recent years there have been movements by consumer groups in order for reduction of
restrictive practices in Australian services of mental healthcare. The possibility of the
movements is that the consumers' groups seek to challenge the mental health practitioners and
government enforcements that stigmatize mentally ill patients and weakens workers' interest.
Mental health services, unlike other healthcare services, are uniquely mandating coercion and
restriction practices to be part of the mental health services (Quinn et al., 2019). The common
coercive measures that are being utilized in Australia are physical restraints, seclusions and to
some extent mechanical restraints. All these forms of coercion and retraining predate the medical
discipline of psychiatry thus modernity. Seclusion is one of the most controversial practices in
delivery of services of contemporary mental health (Alaattinoğlu & Rubio-Marín, 2019). Despite
a call for elimination and reduction in restrain & seclusion in services of mental health, the
practices are still being used all over the mental health facilities. Seclusions is a strategy used in
most of the psychiatric hospitals to cope with aggressive mentally ill inpatients. Historically,
seclusion is one of the oldest approaches that is used to treat mentally ill patients. Aggression is
the primary rationale for using seclusion as a way of restrictive practice. In some psychiatric
settings, seclusion has been used as a form of punishment to the patients
Restrictive and coercive practices are used in mental facilities to protect the consumers
and healthcare professionals from mentally ill aggressive patients. In the ancient times, seclusion
was considered the last option as a mental health service to ensure the staff and consumers safe.
But in recent days, it is considered first which is not right. Seclusion is considered as the most
favorable method compared to the rest of the methods which include physical and mechanical

MENTAL HEALTH 3
restraints. Nurses in conjunction with the consumers disagree with the seclusion method as it was
traumatic to the patients who are mentally ill (Lomas et al., 2017). Therefore, they were for
elimination of seclusion & restraint method. Factors that are considered to decrease the
incidences of restraint & seclusion included creation of a good relationship between the staff and
consumers and making use of the principles of trauma-informed care. Nurses have this notion
that they can use clinical skills to ensure their safety from the aggressive patients rather than
restrictive practices. There exist many initiatives at variable levels that are required to maintain
the healthcare professionals' and consumers safe. These initiatives also move towards realizing
directive measures to eliminate & reduce use of restraint/seclusion practices (Kinner et al.,
2016).
Restrictive practices are used to manage risks or prevent harm due to the patients’
behaviours which may include self-injury, aggression and violence. The restrictive practices are
being considered deleterious since they have physical effects & psychological effects on the
consumer & staff besides complex ethical and legal issues are associated with help of restrictive
practices. Internationally and in Australia, there has been great pressure from the mental
healthcare professionals and consumers to eliminate/reduce coercive and restrictive practices
(Slemon, Jenkins & Bungay 2017). It has been shown that there is a reduction in the use of
seclusion a3nd restraint in Australia but there is still persistent of seclusion practices, mechanical
& physical restraint practices several times with the one consumer or prolonged use on the same
consumers. This calls for an immediate need for better understanding & use of restrictive and
coercive practices and finally, experience of staff working with the mental healthcare consumers
in inpatients (Brunero & Lamont, 2010). Seclusion has shown negative impacts on consumer's
mental healthcare status which includes; consumers argued that seclusion of patients lack

MENTAL HEALTH 4
accountability for the patient’s human rights since the patients were locked in a secluded room
out of their will. The patients are left in a powerless situation since they are robbed of the right of
expression. Seclusion also causes trauma to the consumers. The consumers explained that they
were locked in a room which lacked toilets and left for hours and they were expected to get cured
(Gopalakrishnan, Ambrose & Harvey 2019). This makes it a traumatic experience hence it
affects the recovery process of the patients. Another impact of seclusion is that it is inconsistent
with personal recovery hence it leads to anti-recovery. Nurses have reported that recovery
involves self-direction, self-responsibility which is in contrast to seclusion which is all about
someone else’s control hence it does not help in recovery. Seclusion is also dehumanizing, the
consumers reported that they were not treated normally aa the rest of human beings (Larue et al.,
2016). For instance, being brought food on a tray and left on the door of the cage without any
word from the caregivers they were treated without trust and that not only dehumanizing but is
also demoralizing. Seclusion practices have a positive impact on the healthcare professionals.
Firstly, seclusion enables the professional’s safety. When the aggressive consumers are enclosed
in a secure room, the rate of injury that the consumer is expected to cause is lowered (Mann-Poll
et al., 2018). Hence ensuring safety environment for the professionals. The Seclusion of
aggressive consumers promote a conducive working environment for the patients since they are
controlled and minimizes the healthcare professional workload.
The agenda in Australia for the last decade to reduce & eliminate restraint/seclusion is
reflective in several clinical initiatives and key policy and government directives. The National
Health Consumer and Carer Forum gives a direction that restraint and seclusion aren’t
“evidenced-based therapeutic interventions” and are mostly associated with the abuse of human
rights, the practices also causes both long-term and short-term damages towards the consumer's

MENTAL HEALTH 5
mental health. And as a result, when these restrictive practices are used, they exhibit failure in
treatment (Sweeney et al., 2018). The Australian College Mental Health Nurses (ACMHN) has
published a restraint & seclusion statement in the year 2016 which stated that restrictive practices
also involved the use of chemical restraint should be the last methods to be used and should be
implemented only after consideration of the least restrictive care and implemented by mental
health staff and nurse. The statement stressed on the requirement to respect dignity of the
consumers, meet the consumers’ physical needs while in seclusion/restraint, engage in
appropriate cultural care and stop the practices following legal requirements (Bryson et al.,
2017). The policy stressed the need to research on alternative restrictive practices use that
enhance the consumer's management safely, at a wider level. In the recent days, the World
Health Organization (WHO) has suggested initiatives of Quality Rights as a way of seclusion
and restraint practices elimination in mental health facilities. As restrain & seclusion are
encompassed in a lesser depth in the recently released Australia Fifth National Mental & Suicide
Prevention Plan, seclusion practice is included as a practice to be monitored and addressed
among the twenty-four key performance indicators below the domain of striving for “less
avoided harm” concerning mental healthcare (Ross, 2018).
The role of the registered nurse in collaborating with consumers' work towards
state/territory and national initiatives in reducing seclusions and restraint includes recognition of
the trauma-informed care approaches by the nurses a central nursing care unit rather than using
seclusion and restrain practices. Nurses are consulting the consumers and consumers caregiver
regarding the state of the patients before using seclusion & restraint practices. Registered nurses
have developed evidence-based initiatives which include restraint and seclusion programs that
use the 6 Core strategies that enhance the reduction in the use of restraint and seclusion practices.

MENTAL HEALTH 6
The use of Safewards (Allan et al., 2017) model had resulted to positive effects on reduction &
elimination of restraint and seclusion practices. Safeward is a care model that is designed to
reduce aggression and restrictive practices in the mental health inpatient units. The systematic
review of restraint/seclusion programs, which mostly involves the use of 6 core strategies argues
in favor of programs that reduce restrain and seclusion of mental health inpatients. A post-study
in Australia reported a thirty-six percent reduction in seclusion practice following the Victoria
roll-out program. Such interventions are required to be researched upon whether the reduction
has been maintained at the study site or if new containment methods have been developed and
are used (Fletcher et al., 2017). The Safeward model gives a simple a powerful explanation of
safety rates of consumers and professionals in mental healthcare facilities.
Registered nurses can work together in hand with the National Mental Health
commission in order to strengthen the already existing programs and interventions that are
underway in Australia to help reduce in seclusion & restraint practices in mental healthcare
services. The national Mental Health Commission can also help the nurses to find suitable
resources and initiative that promote elimination of restraint & seclusion practices in the mental
health facilities. By doing this, nurse can come up with appropriate and sustainable alternatives
that may replace the restrictive practices (Martin et al., 2008). The nurses can also work in
partnership with government organization such as Substance Abuse and Mental Health Service
Administration (SAMHSA) to reduce/eliminate restrictive practices by holding national
campaigns against seclusion and restraint practices in mental healthcare facilities. They can also
collaborate with private and public sectors to cultivate the culture of prevention and reduction of
restraints & seclusion. And finally, the collaboration of nurses with SAMHSA can facilitate
training, sustainability and consultation regarding seclusion & restraint to enhance the

MENTAL HEALTH 7
elimination of these practices (LeBel et al., 2014). Despite demonstrated efficacy, seclusion and
restraint reduction initiatives, these practices are still being used worldwide. National data that is
concerned with seclusion, mechanical and physical restraint practices released recently in the
Australian Public Sector of Mental Health hospital services for the years 2016/2017 revealed that
the rates of 7.4, 8.3 & 0.9 events per a thousand bed days respectively. There was a modest
reduction for the seclusion of 6.7 percent in evens from the years 2012-2013 to 2016-2017.
As reduction is positive towards reduction and elimination seclusion and ensuring the
consumers' safety, healthcare professionals’ exhibit resistance towards the elimination of
seclusion & restraint practices completely. In a study of Australian consumers, carers and health
professionals identify harms that are caused as a result of restraint and seclusion. Although, the
harms were less for the consumers and carers to believe that seclusion and restrain elimination
was a desirable option (Ramluggun, Chalmers, Anjoyeb 2018). Barriers/limitations to the
elimination of seclusion and restrain are fear of lack of alternative methods that could be used to
control and maintain the consumer and healthcare professional safety, presence of untrained/ less
experienced staff members in mental health, problematic consumer-staff relationships for
example not responding to the needs of the consumer and physical environmental elements such
as noise that are not conducive in the reduction of aggression and irritation (Brophy et al., 2016).
In conclusion, it has been observed that despite calls for seclusions, mechanical restraint
and physical restraint reduction & elimination reflects at the policy level or research level, the
practices are still in use in Australia as nursed hold on to mix benefits concerning the practices’
elimination. Other than maintaining a safe work environment, health care professionals do not
see the necessity for using the practices. The healthcare professionals are provided with various
alternatives to use unless factors that have already been identified to make a reduction or

MENTAL HEALTH 8
elimination possible such as those indicated in the 6-core strategy, are implemented at
organizational level, reduction and elimination are problematic. Therefore, the effort of
eliminating restraint/seclusion should not only focus on the removal of the barrier that sustain the
use of alternative practices but also enables reduction of containment and elimination.
Elimination of seclusion has a positive impact not only on consumers but also on healthcare
professional’s safety. Additionally, focus on trauma based informed care, educating/training
staff, empathic relation with consumers and team cohesion and collaboration are essential to the
reduction of seclusion practices. Attitudes towards the elimination of restrictive and coercive
practices should be focused on challenging attitudes of restrictive and coercive practices as a
means to prevent injury rates increase. Increasing reflection of staff and increasing
communication with their consumers' attitudes towards seclusion and restraint practices.

MENTAL HEALTH 9
References
Alaattinoğlu, D., & Rubio-Marín, R. (2019). Redress for Involuntarily Sterilised Trans
People in Sweden against Evolving Human Rights Standards: A Critical Appraisal.
Human Rights Law Review, 19(4), 705-732.
Allan, J. A., Hanson, G. D., Schroder, N. L., O’Mahony, A. J., Foster, R. M., & Sara, G. E.
(2017). Six years of national mental health seclusion data: the Australian experience.
Australasian Psychiatry, 25(3), 277-281.
Brophy, L. M., Roper, C. E., Hamilton, B. E., Tellez, J. J., & McSherry, B. M. (2016).
Consumers and their supporters’ perspectives on poor practice and the use of
seclusion and restraint in mental health settings: results from Australian focus groups.
International Journal of Mental Health Systems, 10(1), 120-130.
Brunero, S., & Lamont, S. (2010). Mental Health Liaison Nursing, Taking a Capacity
Building Approach. Perspectives in Psychiatric Care, 46(4), 286-293.
Bryson, S. A., Gauvin, E., Jamieson, A., Rathgeber, M., Faulkner-Gibson, L., Bell, S.,
Davidson, J., Russel, J., & Burke, S. (2017). What are effective strategies for
implementing trauma-informed care in youth inpatient psychiatric and residential
treatment settings? A realist systematic review. International Journal of Mental
Health Systems, 11(1), 5-10.
Fletcher, J., Spittal, M., Brophy, L., Tibble, H., Kinner, S., Elsom, S., & Hamilton, B. (2017).
Outcomes of the Victorian Safewards trial in 13 wards: Impact on seclusion rates and
fidelity measurement. International Journal of Mental Health Nursing, 26(5), 461-
471.

MENTAL HEALTH 10
Gopalakrishnan, S., Ambrose, D., & Harvey, J. (2019). Using self-reflective tools to
understand violence perpetration among patients with personality disorders.
Aggression and Violent Behavior, 49(3), 101-111.
Kinner, S. A., Harvey, C., Hamilton, B., Brophy, L., Roper, C., McSherry, B., &
Young, J. T. (2016). Attitudes towards seclusion and restraint in mental health
settings: findings from a large, community-based survey of consumers, carers and
mental health professionals. Epidemiology and Psychiatric Sciences, 26(5), 535-544.
Larue, C., Goulet, M., Prevost, M., Dumais, A., & Bellavance, J. (2016). Identification and
Analysis of Factors Contributing to the Reduction in Seclusion and Restraint for a
Population with Intellectual Disability. Journal of Applied Research in Intellectual
Disabilities, 31(2), 212-222.
LeBel, J. L., Duxbury, J. A., Putkonen, A., Sprague, T., Rae, C., & Sharpe, J. (2014).
Multinational Experiences in Reducing and Preventing the Use of Restraint and
Seclusion. Journal of Psychosocial Nursing and Mental Health Services, 52(11), 22-
29.
Lomas, T., Medina, J. C., Ivtzan, I., Rupprecht, S., & Eiroa-Orosa, F. J. (2017). A systematic
review of the impact of mindfulness on the well-being of healthcare professionals.
Journal of Clinical Psychology, 74(3), 319-355.
Mann-Poll, P. S., Smit, A., Noorthoorn, E. O., Janssen, W. A., Koekkoek, B., &
Hutschemaekers, G. J. (2018). Long-Term Impact of a Tailored Seclusion Reduction
Program: Evidence for Change? Psychiatric Quarterly, 89(3), 733-746.

MENTAL HEALTH 11
Martin, A., Krieg, H., Esposito, F., Stubbe, D., & Cardona, L. (2008). Reduction of Restraint
and Seclusion Through Collaborative Problem Solving: A Five-Year Prospective
Inpatient Study. Psychiatric Services, 59(12), 1406-1412.
Quinn, C., Ryan, J., Fullam, R., & McKenna, B. (2019). The Use of Restrictive Practices on
Males Released from Prison and Entering Acute Mental Health Services: A
Retrospective Cross-sectional Comparative Study.
https://doi.org/10.1080/01612840.2019.1572845
Ramluggun, P., Chalmers, C., & Anjoyeb, M. (2018). The practice of seclusion: a review of
the discourse on its use. Mental Health Practice, 21(7), 17-23.
Ross, D. (2018). A Social Work Perspective on Seclusion and Restraint in Australia’s Public
Mental Health System. Journal of Progressive Human Services, 29(2), 130-148.
Slemon, A., Jenkins, E., & Bungay, V. (2017). Safety in psychiatric inpatient care: The
impact of risk management culture on mental health nursing practice. Nursing
Inquiry, 24(4), 120-129.
Sweeney, A., Filson, B., Kennedy, A., Collinson, L., & Gillard, S. (2018). A paradigm shift:
relationships in trauma-informed mental health services. BJPsych Advances, 24(5),
319-333.

MENTAL HEALTH 12