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Australians invited to join call for an end to seclusion and restraint of children and adults with mental health problems

11 December 2013


Australians invited to join call for an end to seclusion and restraint of children and adults with mental health problems

The National Mental Health Commission (the Commission) is urging Australians from all walks of life to join them in calling for an end to the seclusion and restraint of children and adults with mental health problems.

‘Seclusion’ is when someone is confined in a specific room from which they cannot leave. ‘Restraint’ is when someone’s movements are restricted by the use of straps or belts (physical or mechanical restraint) or sedation (chemical restraint).

Chair of the Commission Prof. Allan Fels says: “Seclusion and restraint of people with mental health problems is a human rights issue.  It is not therapeutic, it’s a sign of a system under stress, and in fact it adds to people’s trauma.

“I think that many Australians would be shocked to learn that young children are being locked alone in rooms and physically restrained. 

“The data we have shows that child and adolescent units have higher rates of seclusion compared with general units.  When you consider that childhood trauma can often be a precursor to mental illness then this is very worrying”, Prof. Fels said.

For the first time, two sets of national data about the use of seclusion were publically released this year, but Commission remains concerned that they don’t provide people with a clear view of what’s going on in their communities at the service level. 

“While we’re very pleased that our calls for national data on seclusion to be made publicly available were acted on by state and territory governments, we still don’t know the number of people reflected in these data, why they were secluded, and for how long. 

“We are concerned also that the use of seclusion and restraint differs widely across individual facilities and without this level of transparency and accountability, change on the ground is harder.

“The Commission is calling on all governments to commit to releasing consistent, national data on both seclusion and restraint – at a service level – that gives an accurate and meaningful account of what’s really going on.  Most importantly, we reiterate our call for governments to be brave enough to follow this up by setting national targets and reporting against them.

“We very much support the work that is being done to develop a consistent national definition of restraint and we urge that this is given priority so data can also be publicly reported in a comparable way”, Prof. Fels said.

“We also support mechanisms that individuals can go to, to monitor or investigate reported abuses or incidents. Such bodies should have independent powers to change accepted processes and protect human rights.

“There are alternatives to seclusion and restraint in almost every situation.  However, teams must be appropriately resourced and trained, and supported by a culture that values staff who actively engage in preventing situation from escalating in the first place.

“The Commission agrees that the safety of all concerned is paramount, but our end-game is that seclusion and restraint must end, particularly when children are involved.

“Most people will never have heard of seclusion and restraint until it happens to them or a friend or family member.  However, the Commission continues to be contacted and our people are pulled to one side everywhere we go by someone who has a personal story that they want to share.  Given that 45 per cent  of Australians will experience a mental health problem in their lifetime, we believe that many Australians would like to sign up to our Declaration and join us in driving change”, Prof. Fels said.

Meanwhile, the Commission has established a national Seclusion and Restraint Project (the Project) in partnership with the Mental Health Commission of Canada and key Australian partners, including the Safety and Quality Partnerships Subcommittee, the Australian Human Rights Commission, and interested state mental health commissions. 

Conducted by the University of Melbourne, the Project is looking at best practice in reducing and eliminating the use of seclusion and restraint and help identify good practice approaches. Its scope extends beyond the health of the hospital system and facilities (such as inpatient units and emergency departments) to include the use of seclusion and restraint in community, custodial and ambulatory settings (such as remand facilities and patient transport services) and by first responders (such as police). 

A literature review, a survey and focus groups involving people with lived experience will be completed in the coming months and a best practice report will be presented in mid-2014.

You can view and sign up to the Declaration here.


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