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Commission calls for clarity on seclusion and restraint

17 December 2014

The National Mental Health Commission (the Commission) has highlighted the seclusion and restraint of vulnerable Australians as being of particular concern following the release of new, national data by the Australian Institute of Health and Welfare today.

The data shows that nationally, there were eight seclusion events per 1,000 bed days in 2013–14, an average annual reduction of 12.2 per cent since 2009-10. The highest rate of seclusion was for child and adolescent and general services with 9.6 and 9.5 seclusion events per 1,000 bed days, respectively. Older person services had the lowest rate of seclusion events (0.5), a reduction of 34.4 per cent in five years.

Chair of the Commission Prof. Allan Fels said: “While the release of this data is important, it really raises just as many questions as it answers. The Commission is pleased that duration of seclusion events has been included, however we still don’t know the number of people reflected in the data or why they were secluded or restrained. 

"We strongly support the work being done to develop a consistent national definition of restraint, and see this as a key priority so that the publicly reported data can provide a clear and accurate picture of restraint practices.

"We also reiterate our call for governments to commit to setting national targets and reporting against them," Prof. Fels said.

"What we do know is that seclusion and restraint of people with mental health problems is a human rights issue. It adds to people’s trauma and it’s a sign of a system under stress."

Prof. Fels said the Commission is also concerned about the growing use of antipsychotic medication, particularly among children and older people.

"The use of antipsychotic medication in Australia has more than doubled since 1990, and it has skyrocketed among older people in particular. A person in their 80s is now three times more likely to be taking antipsychotic medication than they were in their 30s, 40s or 50s.

"We share concerns raised by others such as Alzheimer’s Australia and the National Prescribing Service that such medications are being used as a first line approach to managing behavioural and psychological symptoms, which may be viewed as a form of chemical restraint.

"The use of antipsychotics in children is also increasing and the Commission questions whether this is being done with informed consent about potential long-term side effects and potential adverse impact of antipsychotic use in children," he said.

The National Mental Health Commission is leading a national Seclusion and Restraint Project with a number of partners. During 2014, the project has completed stakeholder consultation and research, as well as a review of the literature about what has proven to be effective in reducing the use of seclusion and restraint in Australia and overseas. A position paper and associated recommendations to governments are now underway and expected to be released in early 2015.

In the meantime, the Commission invites individuals and organisations who support the reduction and elimination of seclusion and restraint to sign up to the Seclusion and Restraint Declaration on the Commission website.

You can view and sign up to the Seclusion and Restraint Declaration here: www.mentalhealthcommission.gov.au/our-work/national-seclusion-and-restraint-project/the-seclusion-and-restraint-declaration.aspx

"Even the most disadvantaged Australians should be able to lead a 'contributing life,' whatever that means for them and this simple goal will be our touchstone and yardstick."

Chair Prof Allan Fels AO
National Mental Health Commission

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