The Use of Restrictive Measures in an Acute Inpatient Child and Adolescent Mental Health Service

There are significant issues associated with the use of restrictive measures, such as seclusion and restraint, in child and adolescent mental health care. Greater understanding of how restrictive measures are used is important for informing strategies to reduce their use. In this brief report we present a 12-month audit (1/1/2010–31/12/2011) of the use of restrictive measures (seclusion, physical restraint) in one child and adolescent acute inpatient mental health unit in Australia. The study highlights the need for continued efforts to reduce the use of restrictive measures in child and adolescent mental health services. Restrictive measures, such as restraint and seclusion, are used in mental health care to manage patients who are aggressive, suicidal or otherwise at risk of harming themselves and/or others. There are complex legal and ethical issues associated with their use (Moylan, 2009), as well as the potential for physical and psychological harm to patients (Martin, Krieg, Esposito, Stubbe, & Cardona, 2008). Consequently, there has been a global effort to reduce the use of restrictive measures in all mental health settings. Relatively high rates of seclusion and restraint have been reported in child and adolescent mental health services worldwide. In a recent systematic review of international literature, De Hert, Dirix, Demunter, and Correll (2011) report seclusion rates of 26% of patients (67 per 1000 patient days) and restraint rates of 29% of patients (42.7 per 1000 patient days). In Australia, the Australian Institute of Health and Welfare (AIHW) (2013) reported that, nationally, child and adolescent units had a higher rate of seclusion (20.9 events per 1000 bed days) compared with adult units (11.9 per 1000 bed days) in 2011–2012. Understanding how restrictive measures are used in mental health care is an important step towards the reduction or elimination of these practices. More information is needed on the use of these measures in mental health services for children and adolescents (Pogge, Pappalardo, Buccolo, & Harvey, 2013). In particular, there is insufficient data on the behaviours associated with the use of restrictive measures in this population, and no information on the use of strategies to attempt to calm the patient prior to or during the use of these measures (De Hert et al., 2011 and Pogge et al., 2013). In this brief report we present an audit of the use of restrictive measures (seclusion and/or physical restraint) in a child and adolescent mental health unit in Australia.