Reducing restrictive interventions through Innovations and Collaboration: the development of a clinical practice framework and training program for Mental Health Intensive Care in Victoria.

Ms Kate Thwaites1, Ms  Julie Anderson1, Ms Frances Sanders1
1Office Of The Chief Mental Health Nurse, Melbourne, Australia

The framework intends to distinguish Mental Health Intensive Care as a specialist care type that can be delivered across settings . When applied, the concept of Mental Health Intensive Care uses the patient need as the determinant; rather than a defined space. The is intended to support decision making about the use of mental health intensive care, as well as the development of local policies and procedures to ensure consistent standards and to maintain safety. The focus of practice is to reduce restrictions that impede recovery by utilising skills, therapeutic engagement, continuous appraisal, early identification of deterioration, and processes for timely escalation. The training is accompanied by videos of consumer, carer and clinician experiences of restrictive environments and practices and their impact on recovery.
All decisions regarding Mental Health Intensive Care must reflect consideration of consumers’ rights, recovery goals, risks, trauma history and anticipated benefits of the care type. Human rights, supported decision making and least restrictive practices are explicit in the care model and training.

The development of a framework and training has included:
• state-wide review of high dependency units ;
• review of Chief Psychiatrist HDU guidelines.
• engagement with key stakeholders, including clinicians, consumer and carer peaks;
• training was developed, piloted and evaluated by senior consumer, carer and clinical advisors.


Frances Sanders is the Senior Carer Adviser with the Office of the Chief Psychiatrist in Victoria. Prior to this she has worked leading NDIS business development, consumer and carer services and strategy and has held executive roles in the mental health and employment sectors since 1995.


TERP focuses on identifying, avoiding and reducing harm across all environments in which the care of people with mental ill health is provided. TERP inforces Australia’s commitment to reduce the use of, and eliminate restrictive practices as a priority for action. Each jurisdiction, in conjunction with the Safety and Quality Partnership Standing Committee and the Commonwealth Government, works towards this vision by holding a series of forums providing an opportunity to learn and grow from local and national initiatives to eliminate restrictive practices and create a dialogue for future care.

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