Seclusion, mechanical restraint and other restrictive practices
There is a recognised need to reduce and, where possible, eliminate the use of restrictive practices in authorised mental health services. With this goal in mind, the Mental Health Act 2016 introduces additional safeguards.
Under the Act, the Chief Psychiatrist can issue directions in relation to the use of seclusion in authorised mental health services. A direction may relate to an individual patient, a class of patient, or all patients in an authorised mental health service.
A direction may also require that seclusion only be used under a "reduction and elimination plan".
The purpose of a reduction and elimination plan is to authorise the use of seclusion within a plan for its reduction and elimination.
Reduction and elimination plans are approved by the Chief Psychiatrist.
For any patient, seclusion may only be authorised by an authorised doctor for periods of up to 3 hours, and for no more than 9 hours, in any 24-hour period. This may be extended if it is allowed under a reduction and elimination plan approved by the Chief Psychiatrist.
Seclusion must end if it is no longer required.
Mechanical restraint can only be authorised by an authorised doctor with the prior approval of the Chief Psychiatrist.
An approval can only be for up to 7 days. The Chief Psychiatrist may also require an approval to be done under a reduction and elimination plan.
A patient under mechanical restraint must be continuously observed.
For any patient, mechanical restraint may only be authorised by an authorised doctor for periods of up to 3 hours, and for no more than 9 hours, in any 24-hour period.
This may only be extended if it is allowed under a reduction and elimination plan approved by the Chief Psychiatrist.
Mechanical restraint must be removed if it is no longer required.
It should be noted that separate provisions in the Act apply if mechanical restraint is required to transport a patient. The Chief Psychiatrist's approval is also required for the use of the mechanical restraint in these circumstances.
Physical restraint and medication
The Act regulates the use of physical restraint of patients in authorised mental health services. The use of physical restraint must be authorised by an authorised doctor or a health practitioner in charge of the relevant unit. However, exceptions to this apply if the physical restraint is required in urgent circumstances or if it is authorised under another law.
The Act requires that medication, including sedation, must only be given to a patient if it is clinically necessary for the patient's treatment and care.
There are Chief Psychiatrist policies which apply to the use of seclusion, mechanical restraint and other restrictive practices.
Mental Health Review Tribunal
Many of the functions of the Mental Health Review Tribunal continue under the Mental Health Act 2016.
The Tribunal regularly reviews treatment authorities to decide if they should continue and the extent of treatment in the community under the authority. The first review of a treatment authority is to occur within 28 days of it being made.
When reviewing a forensic order, the Tribunal may decide to make a treatment support order. This will assist the recovery of a patient by enabling a patient to "step down" from a forensic order to a treatment support order, when it is appropriate to do so.
The Tribunal also reviews the continuation of treatment support orders on a six monthly basis and only the Tribunal can end treatment support orders.
The Tribunal also approves the transfer of forensic patients into and out of Queensland.
Under the Act, the Mental Health Review Tribunal is required to offer free legal representation for certain proceedings. This applies where the proceeding relate to a minor, where the Attorney-General is represented, for "fitness for trial" reviews, and for applications for electroconvulsive therapy. All electroconvulsive therapy for minors must be approved by the Tribunal.
There are other procedural matters of the Mental Health Review Tribunal which are of interest to authorised mental health services.
A regular review of an authority or order is adjourned if the patient is absent.
The Tribunal can revoke a forensic order or treatment support order if the person is missing for three years.
Reports prepared by treating teams for tribunal hearings must be provided to the Tribunal at least 7 days before the hearing. It is essential that staff of authorised mental health services plan ahead for hearings and provide reports in accordance with the Act.