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

the deliberate confinement of a person, alone, in a room

or area that the patient cannot freely exit

Seclusion

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

Legislative Provisions

National Guidelines

(NMHSR Project)

Codes of Practice or Policy Directives

A Combination of the Above

Outright Ban

Alternatives for Regulation

Current Laws

Most Australian mental health acts contain restrictions on the use of seclusion and mechanical 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.

Current Laws

National Mental Health Commission

One of its ten

recommendations

targets reducing “the

use of involuntary

practices and work to

eliminate seclusion

and restraint”

Prof. Bernadette McSherry

Dr Annegret Kaempf

Assoc. Prof. Janet Clinton

Kay WilsonDr Bridget Hamilton

Cath RoperPiers Gooding

Assoc. Prof. Stuart Kinner

The Project Team

Dr Lisa BrophyAssoc. Prof. Carol Harvey

Advisory Groups & Focus Groups• People with Lived Experience

Advisory Group

(5 members)

• Families and Supporters Advisory

Group

(5 members)

Advisory Groups

Project Plan

Main aim of the projectFind evidence of “best practice” in reducing and/or eliminating seclusion and restraintMixed methods approach

Online surveysCall for evidenceFocus Groups

Target groupsconsumers, families and supportersindigenous populationservice providers“first responders”prisoners

Aim and Approach

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 dataensuring sufficient sample size for various target groupsclearly directed questionsidentification of common issuesevidence and dimensions of surveys• Best delivery of resultswell-considered presentation of data/best practice in a final reportreader-friendly and practice focused

Challenges

© Copyright The University of Melbourne 2011

http://www.socialequity.unimelb.edu.au/seclusion-and-restraint/