Seclusion and restraint

There is a strong commitment nationally and internationally to the reduction and elimination of seclusion and restraint.

The chief psychiatrist may require a reduction and elimination plan for the use of mechanical restraint and seclusion. A plan outlines measures to be taken to proactively reduce use of seclusion or mechanical restraint on a patient by ensuring clinical leadership, monitoring, accountability and a focus on safe alternative interventions.

Form: Reduction and Elimination Plan - Seclusion and Mechanical Restraint

Physical restraint is defined by the Act as the use by a person of his or her body to restrict the patient’s movement.

The use of physical restraint may be authorised only if there is no other reasonably practicable way to:

• protect the patient or others from physical harm
• provide treatment and care to the patient
• prevent the patient from causing serious damage to property, or
• prevent the patient from leaving the service (for persons required to remain in an authorised mental health service).

There are strict requirements for the application, monitoring and review of clinical decisions regarding use of physical restraint as a restrictive intervention.

Policy: Physical restraint

Clinical Note: Physical Restraint

FAQ: Physical Restraint - Adults

FAQ: Physical Restraint - Child and Youth

Mechanical restraint is the restraint of a person by the application of a device to the person’s body, or a limb of the person, to restrict the person’s movement. Mechanical restraint does not include the appropriate use of a medical or surgical appliance in the treatment of a physical illness or injury or restraint that is authorised or permitted under another law.

Mechanical restraint can only be authorised by an authorised doctor with the prior approval of the Chief Psychiatrist and cannot be authorised under an advance health directive, or by an attorney or guardian.

Policy: Mechanical restraint

Form: Application for Approval to Use Mechanical Restraint

Form: Authorisation of Mechanical Restraint

Form: Reduction and Elimination Plan - Seclusion and Mechanical Restraint

Seclusion is the confinement of a person, at any time of the day or night, in a room or area from which free exit is prevented.

Under the Act, seclusion may only be used for an involuntary patient in an authorised mental health service (AMHS) who is subject to a treatment authority, forensic order or treatment support order, or a person absent without permission from another State who is detained in an AMHS.

Seclusion may be authorised by an authorised doctor for up to three hours and for no more than nine hours in a 24-hour period. Seclusion cannot be authorised under an advance health directive, or with the consent of a guardian, attorney or, if the person is a minor, the minor’s parents.

A patient in seclusion must be observed at intervals of no more than 15 minutes for the duration of the seclusion and must be removed from seclusion if it is no longer necessary to protect the person or others from physical harm.

Policy: Seclusion

Form: Authorisation of Seclusion

Form: Release and Return to Seclusion

Flowchart: Authorisation of Seclusion and Emergency Seclusion

Emergency seclusion

In an emergency, a health practitioner in charge of a unit within an AMHS may seclude a person for up to 1 hour until an authorised doctor is available to complete the authorisation of seclusion. Emergency seclusion may be authorised for no more than 3 hours in a 24-hour period.

Form: Emergency Authorisation of Seclusion

Extension of seclusion – reduction and elimination plan

If seclusion is required to be extended beyond the authorised time, continuation of seclusion may be approved under a reduction and elimination plan. If required, a 12-hour extension of seclusion may be authorised to allow a reduction and elimination plan to be prepared for the patient.

Form: Extension of Seclusion

Form: Reduction and Elimination Plan - Seclusion and Mechanical Restraint

Flowchart: Reduction and Elimination Plans and Extension of Seclusion

High secure units

A high security unit authorised mental health service provides treatment and care to patients with significantly challenging behaviours whose risk of harm to self or others cannot be safely managed in a less secure environment. Some patients may require extended periods of seclusion to ensure their own or others’ safety.

Consistent with national priorities, the aim is to minimise the use of seclusion for these individuals while ensuring a safe environment for the patient and others.

Policy: Overnight confinement for security purposes at High Secure Units

There are strict legislative requirements regarding the application, notification, monitoring and reporting of the use of seclusion and restraint.

The health practitioner in charge of an inpatient unit, or other unit within an authorised mental health service must ensure that the patient subject to seclusion or mechanical restraint have their reasonable needs met, including, for example, being given:

• sufficient bedding and clothing
• sufficient food and drink, and
• access to toilet facilities.

In particular instances, the Chief Psychiatrist may also require that a reduction and elimination plan be prepared for a relevant patient, in order for mechanical restraint and/or seclusion to approved. The written plan must be individually tailored and developed by an authorised doctor and include specific information about the strategies proposed to reduce, and eliminate, the use of mechanical restraint on, or seclusion of, the relevant person in future.

Additional protections are in place for children and young people including that the public guardian must be notified if mechanical restraint, seclusion or physical restraint has been used in an authorised mental health service on a patient who is a minor.

The Act provides that a person must not administer medication, including sedation, to a patient unless the medication is clinically necessary for the patient’s treatment and care for a medical condition.

Requirements in relation to the appropriate use of medications are outlined in the Chief Psychiatrist Policy – Clinical Need for Medication.

Policy: Clinical need for medication

FAQ: Acute Sedation - Using medicine to calm - Adults

FAQ: Acute Sedation - Using medicine to calm - Child and Youth