‘Restricting Restraint’ – a local response to an established practice

Mr Russell James3
1Tasmanian Health Service, Hobart, Australia, 2University of Tasmania, Hobart, Australia, 3RMIT University, Melbourne, Australia

The use of restrictive practices within the mental health setting continues to attract significant attention, in particular to lived experience of service users and mental health staff. In spite of the controversy and international recommendations seclusion and restraint continue to be part of everyday psychiatric practices. In its response to the commitment made in Tasmania to reduce the use of and ultimately eliminate restrictive practices, the Department of Psychiatry at the Royal Hobart Hospital established a Restrictive Practices Committee with the aim of reducing and eliminating restrictive practices within the acute mental health setting.
In order to achieve the, what may seem like the unachievable, the restrictive practice committee was established. This small, but determined group of individuals, including people with lived experience of mental illness and carers, mental health clinicians and support staff, work together to identify areas where practice advancements can be made to better support individuals and create safer environments for everyone. With an emphasis on co-production, the committee reviews each event of seclusion and restraint with the aim to develop recommendations for advancements in clinical practices and reducing harm across all environments.
This presentation reflects upon the changes made in the use of restrictive practices within the department; looks at the culture, environment and systemic challenges in restrictive practice reduction, and the commitment made to improve the care and experiences of restrictive practices as well as the vision of eliminating restrictive practices within the mental health setting.


Russell currently works as the Clinical Nurse Consultant within the Department of Psychiatry at the Royal Hobart Hospital and as a Lecturer in Nursing at the University of Tasmania. Russell began his mental health nursing career in 2006 at Alfred Health in Melbourne, working in a range of clinical settings, and as a Clinical Nurse Educator where he worked for 7 years supporting students completing their mental health placement. Russell commenced a PhD Candidature at RMIT University in 2016, with a project titled: Advance Statements within the Mental Health Setting. Russell has an enormous passion for the nursing profession and strives to promote mental health nursing by nurturing and supporting new nurses, harnessing the expertise of experienced staff and works side-by-side with consumers, families and carers.


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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