Review of Strategies for Minimising Use of Restrictive Practices in North Metropolitan Health Service Mental Health Inpatient Units.

Dr Robina Redknap1, Ms Avonia Donnellan1
1North Metropolitan Health Service Mental Health, Wembley, Australia

It is well-recognised that restrictive practices have the potential to result in significant adverse and traumatic consequences for patients and staff, and raise concerns regarding human rights breaches. Beginning in 2007, North Metropolitan Health Service Mental Health (NMHS MH) was one of eleven Beacon Project reference sites responsible for developing and implementing best practice strategies for reducing and, where possible, eliminating the use of seclusion and restraint in public mental health services. Further positive gains in minimising restrictive practices have been made since that time. This project aimed to inform future quality improvement strategies through identifying current barriers and enablers to delivering minimally restrictive treatment and care in NMHS MH inpatient units (including adult, older adult and forensic); and identifying the characteristics of patients at increased risk of restrictive practices. Consultation through an online survey and semi-structured interviews with clinicians, consumers and carers captured multiple perspectives and provided information on a variety of barriers and enablers to minimising restrictive practices. Quantitative data analysis identified patterns across time in the use of seclusion and restraint in NMHS MH inpatient units.

Eight inter-related themes related to action areas for minimising restrictive practices in mental health services were identified: Leadership and Culture of Care, Clinical Governance, Delivery of Care, Partnering with Consumers and Carers, Service Integration, Workforce, Professional Development and Physical Environment. Key findings and their implications for future actions aimed at enhancing delivery of minimally restrictive care will be discussed.


Dr Robina Redknap DHlthSc (ClinLship & Mgt)
Robina has been a mental health nurse for over 38 years and worked in senior clinical, management and educational roles. Currently the Executive Director of Nursing for a large Area health service in Western Australia, Robina has provided leadership to nursing, medical and allied health staff to promote and achieve least restrictive care and enhance patient recovery since the inception of the Beacon Project in 2007.

Avonia Donnellan BA(Psych)Hons, MClinPsych, GradCertEdMgmt
Avonia completed her training in Clinical Psychology in 1993. Since graduating, Avonia has worked as a clinical psychologist and in project, policy and planning roles in the public, private, non-government and university sectors, predominantly with youth and adults. She has a passion for working to enhance accessible, inclusive and recovery-oriented services with a genuine commitment to patient-centred care.


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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