Restrictive Practices in Mental Health Services

30 April 2021

Restrictive and coercive practices in the care of people with mental health conditions are clearly in breach of human rights. There are very few occasions where this can be tolerated.  It is only when clearly there is no other way to ensure the safety of the consumers themselves and the people around them. These episodes of restrictive and/ or coercive practice must be subject to very clear and stringent guidelines. It would be of benefit if these guidelines were consistent across the country.

What are restrictive practices?

Restrictive practices refer to the implementation of any practice or practices that restrict an individual's movement, liberty and/or freedom to act independently without coercion or consequence.

Restrictive practices are not in accordance with the UN Convention on the Rights of People with Disabilities which has concluded that there can be no therapeutic justification for their use in psychiatric facilities.

What incorporates a restrictive practice?

Restrictive practices can include:

  • Seclusion: Where a consumer is deliberately confined, alone, in a room or area that he or she cannot freely exit.
  • Mechanical Restraint: Where a device is used to restrict freedom of movement.
  • Chemical Restraint: Where medication is given for the purpose of controlling a person’s behaviour through sedation. This is a very controversial category and more work needs to be done to clarify the difference between therapeutic sedation and control.
  • Emotional Restraint: Where an individual feels unable to express their views openly and honestly to clinical staff for fear of the consequences.
  • Environmental Restraint: Where the restriction of a person’s free access to all parts of their environment, including access to a room or part of a person’s own home and not being able to access the community.
  • Involuntary Treatment: Where an Involuntary Treatment Order (ITO), a Community Treatment Order (CTO) or a Forensic Order, means that under the law, a person can be treated for their mental illness, often against their wishes.

NMHCCF recommends

The NMHCCF believes recovery approaches and trauma-informed principles assist services to reduce and eliminate the use of restrictive practices. Furthermore, all mental health treatment programs should operate from a positive and strengths-based perspective to provide recovery-oriented, person-centred, trauma-informed and human rights-based practice.

Download the full advoacy brief

Advocacy Brief - Restrictive Practices in Mental Health Services