Department of Health

Reducing restrictive interventions - literature review

The Mental Health Act 2014 further strengthens the impetus to reduce the use of restrictive interventions. It does so by:

  • introducing the regulation of physical restraint as well as strengthening the regulation of mechanical restraint and seclusion 
  • increasing the oversight of and accountability for the use of these restrictive interventions 
    specifying that restraint and seclusion are measures of last resort that should only to be used after less-coercive interventions have been ‘tried or considered and found unsuitable in the circumstances’ (Department of Health 2012a, p. 8).

This literature review was a prerequisite to the development of the new guideline from the Chief Psychiatrist on the use of restrictive interventions to support mental health services in implementing the new legislation (Chief Psychiatrist 2014). The guideline addresses the practice of bodily restraint (including mechanical and physical restraint) and seclusion. The Chief Psychiatrist’s guideline on mechanical restraint (Department of Health 2006) and seclusion (Department of Health 2011) were incorporated into the new guideline.

The Department of Health has commissioned substantial literature reviews that inform this report. Livingstone (2007) conducted a comprehensive literature review on seclusion practices. The focus of another comprehensive literature review was on reducing the use of bodily restraint and seclusion through preventive approaches (Department of Health, 2013b). As valuable as they are, neither review addressed best practice guidelines for restrictive interventions when complex situations arise that require their use.

To fill this gap, this report reviews the literature on the practices of physical restraint, mechanical restraint and seclusion. This report subsequently builds on the comprehensive literature reviews previously commissioned by the Department of Health. In Victoria, the regulation of physical restraint occurs for the first time under the Act. A review of Victorian mental health service policies, procedures and guidelines was also undertaken to identify the extent to which physical restraint is systematically addressed in existing documentation, prior to the implementation of the new legislation.

Reviewed 09 October 2015


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