Chapter 6 Intensive and involuntary service settings

Mental health intensive care units, involuntary settings and criminal justice settings have been identified as challenging environments for Lived Experiences workers, due to the use of involuntary treatment and restrictive practice. Coercive and restrictive practices refer to any intervention or treatment process that either puts pressure on another to act in a certain way or restricts their rights and/or freedom of movement. These practices include seclusion and physical, chemical, mechanical or environmental restraint.

In 2005, all Australian Governments agreed to act to reduce and where possible, to eliminate the use of seclusion and restraint. The National Mental Health Commission states ‘there is strong agreement that seclusion and restraint is a human rights issue, that it has no therapeutic value, that it has resulted in emotional and physical harm for consumers and staff, and that it can be a sign of a system under stress. In addition, there is a lack of evidence internationally to support seclusion and restraint use in mental health services.’

Employing a Lived Experience workforce has been shown to contribute to a more recovery-oriented practice and reduce the need for restrictive practices in acute inpatient settings where restrictive practices are prevalent. However, Lived Experience workers employed in restrictive settings may be at higher risk of experiencing re-traumatisation and need to negotiate boundaries. This can also apply to all health workers in the involuntary setting.

Lived Experience workers should not be expected to be involved in the use of restrictive practices. It is inappropriate for clinicians to request the support of Lived Experience workers in implementing these practices. By understanding this and building it into policy and practice, trust and relationships between people accessing services and Lived Experience workers is strengthened and the morale and authenticity of Lived Experience roles is not compromised.

Co-production of Lived Experience position descriptions and appropriate support strategies for involuntary settings is essential to maintain fidelity to the values and principles of Lived Experience work.

Discussion and advice is obtained from Lived Experience leaders and research, regarding how to develop position descriptions for Lived Experience workers within involuntary settings and what supports are needed to undertake those roles.

Position descriptions in all settings, including involuntary settings, must be clear that Lived Experience workers must never be involved, implicitly or explicitly in coercive or restrictive practice.

 

Training for Lived Experience workers and whole-of-workplace in involuntary settings

Lived Experience workforce in voluntary and involuntary settings should receive training on mental health laws and the rights of people in involuntary settings, as well as understanding what is coercive practice. The whole-of-workplace receives training and clarity on the role of Lived Experience workforce within these settings. Training is provided to tribunal members, and individuals within the broader legal system, (i.e. lawyers and Legal Aid), on the role of Lived Experience workers.

 

Additional considerations for Lived Experience workers in involuntary settings

Additional strategies for maintaining designated Lived Experience role integrity in involuntary settings include:

• Additional support, supervision and debriefing for Lived Experience workers, as well as for non-designated managers and supervisors.
• Support for all staff to be clear about the functions of designated Lived Experience roles (needing to be aligned with lived experience principles and values).
• Provision of opportunity for all staff to work through tensions between provision of mental health laws and human rights instruments such as the Disability Convention and the Declaration of Human Rights.
• Exploration of research together and invitation to Lived Experience academics and researchers to present at training workshops and meetings.

Lived Experience workers in environments where coercive practices are used can be distressed or re-traumatised. Opportunities to debrief these situations with senior Lived Experience workers are essential.

 

Progress towards eliminating coercive and restrictive practices

Research has shown that a well supported Lived Experience workforce can reduce restrictive practices in services. However, it is critical that eliminating coercive and restrictive practice is still viewed as the remit of whole workforce and not the responsibility of the Lived Experience workforce.

An important task in mature stages is exploring how Lived Experience roles can contribute to the sector goal of eliminating coercive and restrictive practices and taking action to support this. Lived Experience contribution to this goal can include:

• working with consumers to develop preventative health plans
• increasing understanding of the impacts of restrictive and coercive practices by sharing their personal experiences
• sharing different narratives and ideas for non-restrictive or coercive practices
• providing specialised advocacy for people accessing services
• providing alternate support rather than restrictive practices
• encouraging leadership from the Lived Experience workforce on reducing restrictive practices
• being an integral part of seclusion review committees
• including at least two Lived Experience workers in settings where restrictive practices occur.