New data has revealed how often mental health patients in Australia’s public hospitals are being restrained — either by being strapped or held down — with advocates warning the practice re-traumatises people and delays their recovery.
The Australian Institute of Health and Welfare (AIHW) report revealed people were being held down on average at a rate of nine times for every 1,000 days spent in a facility.
Mechanical restraints such as straps, belts and manacles were less-commonly used, at under two events per 1,000 bed days.
Nationally, children were being physically restrained 10.9 times per 1,000 days in a mental health bed, while forensic services — which includes prisoners — was far higher at 110.2 incidents per 1,000 days.
Around the country, Victoria had the highest rate of physical and mechanical restraint incidents in public hospitals.
However the report notes the low ratio of mental health beds per person in Victoria compared with other places could be inflating the use of restraints, while data collection methods across the states was not consistent.
This is the first time such data has been made available, and while it shows the use of restraint is declining, mental health advocates hope it will lead to a further reduction or elimination of the practice.
The report comes shortly after staff in South Australia’s Oakden facility were suspended over allegations of restraint and severe mistreatment of dementia sufferers at the state-run facility.
‘Of course I fought back … it was terrifying’
Mental health advocate Indigo Daya told the ABC the use of physical restraint when she was admitted as a patient, such as being held down and forced to take medication, and being isolated in a locked room, was extremely harmful.
“I was abducted and raped as a child so for me, to have strangers come to my house and then take me away, take me to a place that was really scary, make me strip, search me, give me substances so that I didn’t know what was happening …
“It was like an absolute re-creation by the health service of the worst trauma in my life.”
Ms.Daya said she believed the intent was to be helpful and therapeutic, but it had profoundly negative affects.
“Of course I fought back, because this was terrifying to me, which just reinforced the idea that I was really mad and unsafe, and meant that I was even more restricted,” she said.
“That failure to understand that most of us who end up in a psychiatric unit, have a history of profound trauma … for me that’s often at the heart of why this stuff continues to happen, and that’s what gets in the way of changing it.”
Eliminate seclusion and restraint: Mental health chief
Mental Health Australia chief executive Frank Quinlan said restraint was almost always avoidable and preventable.
“I think any rate is unacceptably high; we have to be working towards practices that eliminate seclusion and restraint,” he said.
He also warned health practitioners to be careful that the reporting of physical restraint did not precipitate the increased use of chemical restraint to manage people, which was not recorded in the survey.
Mr Quinlan called for better resourcing in the mental health sector.
“I think there can be little doubt that, particularly where staffing is limited, these practices can be more prevalent,” he said.
‘They think of One Flew Over the Cuckoos Nest’
Western Australia’s chief psychiatrist, Dr Nathan Gibson, who is chairing a national forum in Perth examining the use of restraints, said the health service needed to do everything they could to avoid re-traumatising mental health patients while they were receiving treatment.
“We must have some national frameworks around this,” he said.
The forum would release national principles around how to communicate with patients, carers and families about the use of restraint, he said.
He said less-traumatising alternatives could be considered, including:
- comfort rooms — which include music and weighted blankets and comfortable chairs
- safety plans — where patients list possible triggers and ways to help if they become distressed
But he said much had already been achieved.
“People look at this [use of physical restraint] and think, ‘oh, how terrible’ … they think of One Flew Over the Cuckoos Nest or The Snake Pit,” he said.
“I think we have to know that there has been significant amount of work done to improve humanistic care in mental health services, and that the vast majority of work and care that goes on is high-quality, humane care.”
WA Association for Mental Health chief executive Rod Astbury said there was room for improvement.
“The mental health sector … needs to train and equip health professionals with skills in trauma-informed care, and develop their ability to deliver alternative techniques, such as de-escalation, emotional restraint and persuasion,” he said.
This piece by Rebecca Trigger was originally published on ‘ABC News’ 5 May, 2017.