Learn about the Queensland Chief Psychiatrist policies for seclusion and physical and mechanical restraint at authorised mental health services.
Treating patients under the Mental Health Act 2016This page includes information about the following Chief Psychiatrist policies.
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Policy
These policies are mandatory for all authorised mental health services (AMHSs). An authorised doctor, authorised mental health practitioner, AMHS administrator, or other person performing a function or exercising a power under the Mental Health Act 2016 must comply with these policies.
You can also find additional fact sheets, forms, clinical notes and resources that are available for these policies under the relevant subtopics on this page.
The Mental Health Act 2016 regulates seclusion, mechanical restraint, physical restraint and other practices in authorised mental health services.
Seclusion and mechanical restraint may only be used when strict criteria in the Mental Health Act 2016 are met including that there is no other reasonably practicable way to protect the relevant patient or others from physical harm.
Restrictive interventions are last resort measures that must only be used when all other available clinically appropriate interventions have been considered, there remains an imminent risk of harm and the potential impacts of using the restrictive intervention have been considered. Alternative options, include but are not limited to, verbal strategies, de-escalation techniques and other evidence-based strategies such as sensory modulation. These alternatives should be used in the first instance to help the patient safely gain control of their behaviour.
When a clinical decision is made to use a restrictive intervention, it must be applied in the least restrictive way possible. The importance of maintaining the dignity, respect and human rights of people receiving care within mental health services is the cornerstone of providing contemporary care.
The following principles must be applied in the use of seclusion and physical and/or mechanical restraint:
Physical restraint is defined by the Mental Health Act 2016 as the use by a person of his or her body to restrict the patient’s movement.
This may mean holding a part of the person’s body (like their arms or legs), or holding the person so that they can’t get up. Physical restraint may be authorised under the Act to prevent harm to the person, other people or property.
Physical restraint does not include giving support for a person to carry out daily activities, or to redirect a disoriented person such as holding a person’s hand to help them step down safely or using a hand on a shoulder to move the person towards a group activity.
The use of physical restraint may be authorised only if there is no other reasonably practicable way to:
There are strict requirements for the application, monitoring and review of clinical decisions regarding use of physical restraint as a restrictive intervention.
It is an offence to use physical restraint on a person in an authorised mental health service other than in accordance with the Mental Health Act 2016, except where the restraint is authorised under another law
Mechanical restraint is the restraint of a person by the application of a device to the person’s body, or a limb of the person, to restrict the person’s movement.
Mechanical restraint does not include the appropriate use of a medical or surgical appliance in the treatment of a physical illness or injury or restraint that is authorised or permitted under another law.
Mechanical restraint can only be authorised by an authorised doctor with the prior approval of the Chief Psychiatrist and cannot be authorised under an advance health directive, or by an attorney or guardian.
There are strict requirements for the application, monitoring and review of clinical decisions regarding use of mechanical restraint as a restrictive intervention.
It is an offence to use mechanical restraint in an authorised mental health service other than in accordance with the Mental Health Act 2016.
The use of mechanical restraint for the transport and transfer of patients is governed by separate provisions of the Mental Health Act 2016 and is outlined in the Chief Psychiatrist Policy - transfer and transport.
Seclusion is the confinement of a person, at any time of the day or night, in a room or area from which free exit is prevented.
There are strict requirements for the application, monitoring and review of clinical decisions regarding use of seclusion as a restrictive intervention.
The seclusion provisions in the Mental Health Act 2016 may only be applied to a relevant patient in an authorised mental health service. A relevant patient is:
Seclusion may be authorised by an authorised doctor for up to 3 hours and for no more than 9 hours in a 24 hour period.
Seclusion can't be authorised under an advance health directive, or with the consent of a guardian, attorney or, if the person is a minor, the minor’s parents.
A patient in seclusion must be observed at intervals of no more than 15 minutes for the duration of the seclusion. The person must be removed from seclusion if it's no longer necessary to protect the person or others from physical harm.
Read the Seclusion policy to learn more.
In an emergency, a health practitioner in charge of a unit within an authorised mental health service may seclude a person for up to 1 hour until an authorised doctor is available to complete the authorisation of seclusion.
Emergency seclusion can't be authorised for more than 3 hours in a 24 hour period.
If seclusion is required to be extended beyond the authorised time, continuation of seclusion may be approved under a reduction and elimination plan.
If required, a 12 hour extension of seclusion may be authorised to allow a reduction and elimination plan to be prepared for the patient.
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The Chief Psychiatrist may require a reduction and elimination plan for the use of mechanical restraint and seclusion. A plan outlines measures to be taken to reduce use of seclusion or mechanical restraint for a patient and to reduce the potential for trauma and harm.
The reduction and elimination plan reinforces efforts to proactively reduce the use of the restrictive practice by ensuring clinical leadership, monitoring, accountability and a focus on safe, less restrictive alternatives.
An approved reduction and elimination plan must be in place for any patient who is secluded or mechanically restrained for more than 9 hours in a 24 hour period. It is recommended practice to have one in all instances where a patient is secluded or mechanically restrained, in particularly where multiple instances of seclusion or restraint occur.
A reduction and elimination plan must not be approved for longer than 7 days. If a patient requires seclusion or mechanical restraint over a period of 7 days, a new reduction and elimination plan must be submitted to the Chief Psychiatrist for approval.
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There are strict legislative requirements regarding the application, notification, monitoring and reporting of the use of seclusion and restraint.
The health practitioner in charge of an inpatient unit, or other unit within an authorised mental health service must ensure that the patient subject to seclusion or mechanical restraint have their reasonable needs met, including being given:
In particular instances, the Chief Psychiatrist may also require that a reduction and elimination plan be prepared for a relevant patient, in order for mechanical restraint or seclusion to be approved.
The written plan must be individually tailored and developed by an authorised doctor and include specific information about the strategies proposed to reduce, and eliminate, the use of mechanical restraint on, or seclusion of, the relevant person in future.
Additional protections are in place for children and young people including that the public guardian must be notified if mechanical restraint, seclusion or physical restraint has been used in an authorised mental health service on a patient who is a minor.
Learn more about treatment and care for children and minors under the Mental Health Act 2016 or patient rights.
Reducing restrictive interventions in mental health services is a national priority that is supported by local, state, national and international frameworks, policies and legislation.
The Chief Psychiatrist is committed to minimising and where possible eliminating seclusion and restraint in mental health settings. Work is being undertaken that will support and encourage local reform initiatives to reduce and where possible eliminate the use of restrictive practices, promote safety and minimise harms caused by their use.
Read our review of the use of seclusion and restraint to learn more about our response and what we're doing.
A high security unit authorised mental health service provides treatment and care to patients with significantly challenging behaviours whose risk of harm to self or others cannot be safely managed in a less secure environment.
Some patients may require extended periods of seclusion to ensure their own or others’ safety.
Consistent with national priorities, the aim is to minimise the use of seclusion for these individuals while ensuring a safe environment for the patient and others.
All requirements set out in the Mental Health Act 2016 and the Chief Psychiatrist's seclusion policy apply to patients in a high security unit.
Last updated: 5 September 2024