Comparing efforts across jurisdictions in assisting mental health services toward elimination of restrictive practices: Two case studies

Prof Brian Mckenna1
1Auckalnd University Of Technology, Auckland, New Zealand

There are marked variations in the use of restrictive practices across jurisdictions. In some countries, certain practices are not used at all, while specific practices are more pronounced in some countries than others. Social attitudes and clinical traditions are attributed as accounting for such variations.
In Massachusetts (USA), a systems-wide approach to reducing the use of seclusion was achieved primarily through monitoring visits by an external authority, which assisted staff to change workplace cultures to align with reducing restrictive practices and to introduce evidenced-based reduction practices. This external authority is similar to the positions held by the Victorian Department of Health and Human Services (DHHS) and Te Pou o te Whakaaro Nui (Te Pou) in New Zealand. However, little is understood about the precise mechanisms, by which these authorities assist mental health services and the impact of their efforts.
A case study was undertaken with each organisation including interviews with key leaders to explore the strategies used to assist services (DHHS, n = 10; Te Pou, n = 6). Interviews with the person primarily responsible for the reduction of restrictive practices in mental health services served by the organisations were also undertaken (Victoria, n = 21; New Zealand, n = 20).
Marked similarities and some variations were detected in the approaches undertaken in each jurisdiction, which allowed the determination of best practice for authorities supporting the elimination of restrictive practices across other jurisdictions. These findings will be discussed.


Brian is a Registered Nurse and Professor of Forensic Mental Health at Auckland University of Technology and the Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, New Zealand. He is also an Adjunct Professor at the Centre for Forensic Behavioural Sciences at the Swinburne University of Technology. He has published widely on research in forensic mental health, and the interface between clinical practice and mental health law. This includes research on working toward the elimination of restrictive practices. The intent of this research has been translational; to assist mental health services to provide optimum service delivery for the benefit of service users.


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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