The Regulation of Seclusion
and Restraint and Human
Rights – Where to From Here?
A National Mental Health
Commission initiative in
collaboration with the
University of Melbourne
ANZAPPL Conference
Adelaide, 30 November 2013
Overview
Definitions
Alternatives for Regulation
Project Methodology and
Challenges
Seclusion
Seclusion
the deliberate confinement
of a person, alone, in a room
or area that the patient
cannot freely exit
Restraint
• Physical: means bodily force that
controls a person’s freedom of
movement
• Chemical: means medication given
primarily to control a person’s
behaviour, not to treat a mental illness
or physical condition
• Mechanical: means a device that
controls a person’s freedom of
movement
Definitions from Tasmanian Mental Health Act 2013
NMHCCF Definitions
Emotional restraint
“occurs when the individual
consumer is conditioned to
such an extent that there is
a loss of confidence in
being able to express their
views openly and honestly
to clinical staff for fear of
the consequences”
International Trends
UN Special Rapporteur on
Torture has called for "an
absolute ban on…restraint
and solitary confinement of
people with psychological or
intellectual disabilities…in all
places of deprivation of
liberty, including in
psychiatric and social care
institutions”.
Juan E. Méndez
Alternatives for
Regulation
Current Laws
• Most Australian mental health acts contain
restrictions on the use of seclusion and mechanical
Current
Laws
restraints (New South Wales has guidelines).
• The Tasmanian Mental Health Act 2013 and the
New South Wales guidelines refer to physical and
chemical restraint. The South Australian Mental
Health Act 2009 has a principle that “medication
should be used only for therapeutic or safety
reasons”.
• None refer to emotional restraint.
National Mental Health
Commission
One of its ten
recommendations
targets reducing “the
use of involuntary
practices and work to
eliminate seclusion
and restraint”
The Project Team
Prof. Bernadette
McSherry
Assoc. Prof.
Janet Clinton
Assoc. Prof.
Carol Harvey
Assoc. Prof.
Stuart Kinner
Dr Lisa Brophy
Dr Bridget
Hamilton
Dr Annegret
Kaempf
Piers Gooding
Cath Roper
Kay Wilson
Advisory Groups
• People with
Lived Experience
Advisory
Groups & Focus
Groups
Advisory Group
(5 members)
• Families and Supporters Advisory
Group
(5 members)
Aim and Approach
• Main aim of the project
– Find evidence of “best practice” in reducing
Project Plan
and/or eliminating
seclusion and restraint
• Mixed methods approach
– Online surveys
– Call for evidence
– Focus Groups
• Target groups
– consumers, families and supporters
– indigenous population
– service providers
– “first responders”
– prisoners
Overall Process
Progress to Date
• Literature Review
• Website and survey
development
• Ethics application
The Literature
• Changes to the physical
environment
• Organisational change
• Alternative techniques for
managing aggression
Challenges
• Definitions
• Survey data
Challenges
– ensuring sufficient sample size for various target
groups
– clearly directed questions
– identification of common issues
– evidence and dimensions of surveys
• Best delivery of results
– well-considered presentation of data/best practice
in a final report
– reader-friendly and practice focused
http://www.socialequity.unimelb.edu.au/seclusion-and-restraint/
© Copyright The University of Melbourne 2011