1. The Regulation of Seclusion and Restraint and Human Rights – Where to From Here? A National Mental Health Commission initiative in collaboration with the University of Melbourne ANZAPPL Conference Adelaide, 30 November 2013

2. Overview Definitions Alternatives for Regulation Project Methodology and Challenges

3. Seclusion the deliberate confinement of a person, alone, in a room or area that the patient cannot freely exit Seclusion

4. Restraint Physical: means bodily force that controls a person’s freedom of movement Chemical: means medication given primarily to control a person’s behaviour, not to treat a mental illness or physical condition Mechanical: means a device that controls a person’s freedom of movement Definitions from Tasmanian Mental Health Act 2013

5. NMHCCF Definitions Emotional restraint “occurs when the individual consumer is conditioned to such an extent that there is a loss of confidence in being able to express their views openly and honestly to clinical staff for fear of the consequences”

6. International Trends UN Special Rapporteur on Torture has called for "an absolute ban on…restraint and solitary confinement of people with psychological or intellectual disabilities…in all places of deprivation of liberty, including in psychiatric and social care institutions”. Juan E. Méndez

7. Alternatives for Regulation

8. Current Laws Most Australian mental health acts contain restrictions on the use of seclusion and mechanical restraints (New South Wales has guidelines). The Tasmanian Mental Health Act 2013 and the New South Wales guidelines refer to physical and chemical restraint. The South Australian Mental Health Act 2009 has a principle that “medication should be used only for therapeutic or safety reasons”. None refer to emotional restraint. Current Laws

9. National Mental Health Commission One of its ten recommendations targets reducing “the use of involuntary practices and work to eliminate seclusion and restraint”

10. Prof. Bernadette McSherry Dr Annegret Kaempf Assoc. Prof. Janet Clinton Kay WilsonDr Bridget Hamilton Cath RoperPiers Gooding Assoc. Prof. Stuart Kinner The Project Team Dr Lisa BrophyAssoc. Prof. Carol Harvey

11. Advisory Groups & Focus Groups People with Lived Experience Advisory Group (5 members) Families and Supporters Advisory Group (5 members) Advisory Groups

12. Project Plan Main aim of the project –Find evidence of “best practice” in reducing and/or eliminating seclusion and restraint Mixed methods approach –Online surveys –Call for evidence –Focus Groups Target groups –consumers, families and supporters –indigenous population –service providers –“first responders” –prisoners Aim and Approach

13. Overall Process

14. Progress to Date Literature Review Website and survey development Ethics application

15. The Literature Changes to the physical environment Organisational change Alternative techniques for managing aggression

16. Challenges Definitions Survey data –ensuring sufficient sample size for various target groups –clearly directed questions –identification of common issues –evidence and dimensions of surveys Best delivery of results –well-considered presentation of data/best practice in a final report –reader-friendly and practice focused Challenges

17. © Copyright The University of Melbourne 2011 http://www.socialequity.unimelb.edu.au/seclusion-and-restraint/