Victorian Mental Illness Awareness Council reveals use of seclusion and restraint in mental health services

A damning report has revealed the prevalence of “abhorrent” practices in one state’s health system as the fight for change continues.

A damning report from the Victorian Mental Illness Awareness Council (VMIAC) has found the “abhorrent” use of seclusion and restraint is still prevalent within the state’s mental health services.

The contentious restrictive practices of restraint (using physical, mechanical, bodily, chemical or physiological restraint to immobilise someone) and seclusion (confining someone to a room or enclosed space from which they cannot leave) are regulated under the Mental Health Act 2014.

But they should only be used “after all reasonable and less restrictive options have been tried or considered”.

A Royal Commission into Victoria’s Mental Health System tabled in March 2021 recommended that the state government “act immediately” to reduce the use of seclusion and restraint in mental health services, with the aim of eliminating them completely within 10 years.

The government has also had framework in place since 2013 to reduce the restrictive practices, which it called “essential” to providing safe mental health services.

But VMIAC’s third annual Seclusion Report found that 27.75 per cent of patients experienced the restrictive practices last year.

The findings, released on Wednesday, revealed there were 7461 episodes of seclusion or restraint out of 26,884 admissions to Victoria’s inpatient mental health services in 2020–2021.

Sunshine Hospital (20.7), Box Hill Hospital (4.6) and St Vincents Hospital (20.4) had the worst rates for seclusion, mechanical seclusion and physical restraint respectively for adult inpatient units.

Werribee Hospital (3.8), Geelong Hospital (2.0) and Bending Hospital (8.6) experienced the largest increases in those respective restrictive practices as well.

People identifying as Aboriginal and/or Torres Strait Islander were also secluded and restrained at higher rates than other people.

ATIS people made up 3.5 per cent of all inpatients but 5.3 per cent of all seclusions.

Country of birth was also associated with how likely people were to be secluded or restrained.

There have been long-held concerns over the mental and physical impacts of seclusion and restraint, with fears it can lead to damaging feelings, serious physical injury and even death

Anonymous consumer submissions in the report attested to the potentially damaging effects of the restrictive practices.

“Seclusion and restraint were incredibly counter-productive and damaging for me. I think they could have been prevented if the environment had been calming, if I had not been left alone, and if a compassionate practitioner had built rapport with me,” one anonymous consumer submission said.

“The use of restrictive interventions has been linked to retraumatisation of past experiences, serious injuries and even death,” another said.

VMIAC chief executive Craig Wallace said the “sombre” report was “painful” to read.

“The Seclusion Report is a sombre but incredibly important task for VMIAC, and it makes for painful reading. Like CEOs before me, I look forward to the day when we no longer have to produce reports which hold so many traumas and serious human rights breaches,” he said.

“This year’s Seclusion Report highlights, yet again, that Victoria is lagging behind Australia in its use of seclusion and restraint.”

While consumers welcomed the royal commission’s recommendation to eliminate restrictive practices, Mr Wallace feared the 10-year timeframe was too far away.

“Consumers have told us they feel heartened that the Royal Commission into Victoria’s Mental Health System recommended eliminating seclusion and restraint,” Mr Wallace said.

“This policy imperative is long overdue; however, we are concerned at the overly long timeframe of 10 years.

“It is intolerable to imagine the tens of thousands more avoidable traumas that will happen if Victoria doesn’t move faster.”

Originally published as Seclusion and restraint still prevalent in Victoria’s mental health services