source : the age
Hospitals have been put on notice after the state’s wellbeing watchdog found concerning trends among recent complaints by Victorians who were restrained or secluded during a mental health crisis.
The Mental Health and Wellbeing Commission says it has uncovered issues with hospital paperwork, including – in four instances – a failure to demonstrate proper authorisation to undertake restrictive practices as required by law.
Fairfield resident Julie Dempsey says physical restraint and seclusion as a mental health patient left her feeling broken. A new report shows she is not alone.Credit: Simon Schluter
In 14 cases – almost half of all cases reviewed by the commission – hospitals could not prove that they had provided proper food and water, a bedpan or a private room for the removal of clothing.
The watchdog says its findings – detailed in a 20-page report obtained exclusively by The Age – should be a wake-up call for emergency departments, medical wards and inpatient facilities.
Restraint in Victorian healthcare settings can include physical restraint – when someone is held down by a person or people – or mechanical restraint, when a device is used to restrict movement. There is also chemical restraint, when a drug is used to control a person’s behaviour.
Seclusion involves a patient being confined to a room. Each type of intervention is supposed to be used only after all reasonable and less restrictive options have been exhausted, and only to prevent serious and imminent harm to the patient or another person.
“We are concerned about the high level of inaccuracy and incompleteness of documentation found,” the commission’s report says.
“Facilities and supplies provided to ensure the person’s dignity is protected, as well as trauma-informed, gender-sensitive and person-centred steps … were often not documented, or details were not provided of what was done to achieve these requirements.”
The commission reviewed 33 human rights complaints received by it and its predecessor between 2022 and 2024. The watchdog did not review every complaint it received because some fell outside its scope.
In 64 per cent of those it did examine, the watchdog identified issues with missing, incorrect or incomplete authorisation paperwork. Of those 21 cases, it was not known or clear whether bodily restraint was properly authorised under the relevant legislation in four instances.
Fourteen, or 42 per cent of complaints, did not document or demonstrate that appropriate facilities and amenities were provided.
Of the four cases in which patients had an advanced statement of preferences in place, these care plans were considered in only two instances.
Most of the complaints examined by the commission related to physical restraint, mechanical restraint or both. More than half of the incidents occurred in an emergency department.
Recommendation 54 of the Royal Commission into Victoria’s Mental Health System proposed the elimination of restrictive practices within 10 years. The state Labor government accepted this recommendation, which is due to come into effect by 2031.
Fairfield-based mental health advocate Julie Dempsey gave evidence to the royal commission and told The Age she had been restrained on almost every occasion she had entered the hospital system for mental health treatment. She was first hospitalised in 1981, when she was in her early 20s, and was diagnosed with schizophrenia a year later.
Dempsey said a particularly bad experience with forcible restraint, which occurred in 2008, had left her “completely broken”.
She said being “taken down” in full view of other patients was not only humiliating for her, but distressing for others. She added that on one occasion when she was placed in seclusion, she was put in a room without a bedpan and male nurses would stand in the doorway when she was escorted to use a toilet. She didn’t want to shower because of the same privacy issues.
During other times, there would be male security guards observing her being stripped and injected with medication. The ill-fitting pyjamas she would eventually be put in, she says, partially exposed her breasts.
“The local security guard, I’d see him at the shops. He’d seen me stripped. That was so humiliating and degrading.”
For Dempsey, what happened to her wasn’t just something to be reported on paper, it was a breach of basic human rights.
“You feel like an animal in a zoo. I think sometimes animals in the zoo get treated better than people being subjected to restrictive practices.
“My personal message is we need to get serious about culture change. It’s not enough to have laws in place and a new Mental Health and Wellbeing Act and a few posters on the wall. Unless they do dedicated culture-focused work led and informed by people with lived experience, real, meaningful change for consumers is going to be hard.”
According to the latest national figures, during the 2022-23 financial year, there were just over 1100 instances of mechanical restraint across Australia. Physical restraint was used in 16,452 cases.
There were six instances of seclusion per 1000 bed days in Australia during the 2022-23 financial year.
In Victoria, there were 10 instances of seclusion per 1000 bed days between July and September last year. Advocates are awaiting the latest figures for the use of restraint, which the government says are held by the Office of the Chief Psychiatrist.
The first plank in Victoria’s strategy for the elimination of seclusion and restraint is almost a year overdue. Consultation closed in July 2023, and an interim report has not been released publicly, despite a commitment to do so by early last year.
Victorian Mental Illness Awareness Council spokesperson Meghan Bourke said this was one of the reasons why she was not surprised by the commission’s findings.
“We’re supposed to eliminate these practices six years from now,” she said. “Not only do we not have a strategy – where is it? – but where is the funding commitment? There is no meaningful commitment to eliminate these practices.”
Bourke said seclusion and restraint was a key advocacy area for her organisation.
“This is where a lot of the harm occurs. We know that folks who experience restrictive practices are more likely, once they leave a service, to go out and harm themselves. So it’s a bit of a joke sometimes when people say we’re worried about you, so that’s why we’re doing this for you.”
Mental Health and Wellbeing Commission consumer commissioner Maggie Toko said: “Restrictive practices can be harmful and traumatic, and we need services to step up, take their reporting responsibilities seriously and provide consumers with the quality of treatment they deserve.”
An Allan government spokesperson said there had been a 20 per cent reduction in the use of physical restraint – and a 30 per cent decline in the use of mechanical restraint – in the 18 months to April 2024.
State opposition mental health spokeswoman Emma Kealy.Credit: Eddie Jim
“We take the matters highlighted in the report very seriously,” the spokeswoman said. “We are working with the Department of Health on the relevant steps to monitor, address and improve these issues.”
The department will host a clinical forum in March with emergency department bosses to discuss the issues they are experiencing and offer support.
The spokesperson did not say why the interim seclusion and restraint elimination strategy has not been released publicly.
Coalition mental health spokeswoman Emma Kealy said Mental Health Minister Ingrid Stitt needed to explain what had happened to the strategy.
“The biggest issue with seclusion and restraint is it’s the simplest but most brutal way to deal with insufficient staffing, and goes to broader workforce shortage issues,” Kealy said.
“It’s a double failure for Labor – they have fallen behind on implementation to the royal commission’s recommendations around ending seclusion and restraint within 10 years, plus have failed to begin the workforce capacity work that was recommended in the interim report way back in 2019.”
