www.mhcc.vic.gov.au

Michelle – Restrictive interventions and public mental health services

Complaint story about restrictive interventions in a Victorian public mental health service.

Please note: this complaint story includes an instance of self-injury and restraint.

What Michelle told us

Michelle contacted the MHCC after being mechanically restrained in an emergency department (ED). This was because she had been assessed as being at risk of self-harm and of leaving the hospital. Michelle told us she was restrained by her wrists and ankles for hours and was not allowed to use a toilet, just a bedpan. She was also not reviewed by a doctor the entire time. The restraint had left her distressed and traumatised, and she was upset that staff had not sought or listened to her views about what could have prevented it.

Michelle’s rights

The Mental Health Act 2014 (the Act) protects the rights of people who are receiving mental health treatment from a public mental health service. It states that restrictive interventions (restraint and seclusion) can only be used to ‘prevent imminent and serious harm to the person or another person’ or to ‘administer treatment’ and ‘after all reasonable and less restrictive options have been tried or considered and have been found to be unsuitable’ (sections 105 & 113).  The Victorian Government shares a national commitment to the goal of eliminating restrictive interventions in mental health services.

The Act is clear that a person must immediately be released from mechanical restraint when it is no longer necessary to prevent harm or administer treatment. The Chief Psychiatrist’s guideline on restrictive interventions in designated mental health services also say that they should only be used as a last resort, and can cause serious trauma and injuries.

In addition, the mental health principles of the Act relevant to Michelle’s complaint say:

a) Provide least restrictive treatment

Persons receiving mental health services should be provided assessment and treatment in the least restrictive way possible with voluntary assessment and treatment preferred.

b) Promote recovery

Persons receiving mental health services should be provided those services with the aim of bringing about the best possible therapeutic outcomes and promoting recovery and full participation in community life.

c) Ensure supported decision making

Persons receiving mental health services should be involved in all decisions about their assessment, treatment and recovery and be supported to make, or participate in, those decisions, and their views and preferences should be respected.

e) Promote rights, dignity and autonomy

Persons receiving mental health services should have their rights, dignity and autonomy respected and promoted.

These principles and requirements of the Act need to be interpreted along with section 10 of the Charter of Human Rights and Responsibilities Act 2006 (Vic). This says people cannot be treated or punished in a cruel, inhuman or degrading way.

What we did

Michelle’s experiences of mechanical restraint raised serious questions for the MHCC about the ED’s practices and whether there had been breaches of the Act and the Charter. The MHCC asked the service to provide a response to these issues as well as copies of Michelle’s clinical records.

In it’s response the service acknowledged that, in Michelle’s case, the requirements around mechanical restraint had not been met. The clinical records showed that there had not been regular reviews with Michelle to consider other ways of responding to her needs. The service said it would make improvements to prevent similar incidents occurring in EDs, such as training staff on ways of reducing restrictive interventions. They also made a legal undertaking to the MHCC to take the agreed action. Undertakings are an important regulatory tool to promote compliance with the Act. They mean the MHCC can formally follow up the service and issue a compliance notice if the action is not taken. 

In addition, the MHCC facilitated a meeting between Michelle and the service. This gave her the opportunity to communicate her experience to senior staff, including the Clinical Director. Michelle was pleased that the Clinical Director apologised without reservation for her experience. It was further agreed at the meeting that:

  • the Manager of the ED would provide Michelle’s feedback to the staff referred to in the complaint
  • the service would develop a Care Plan for all of the service’s EDs, with Michelle’s input
  • Michelle would make an educational video for ED staff about the impacts of restrictive interventions and how to prevent them after the meeting

The MHCC followed up with the service to confirm that all actions had been completed.

Outcomes

Michelle told us later that she found working with the service to develop the ED Care Plan and educational video very positive. She said the service’s acknowledgement of her experiences, the actions they had taken and the apology she had received were very important to her. Michelle felt that her relationship with the service has become a productive and therapeutic one and enabled her to feel supported in her recovery.

On this basis, the MHCC closed the complaint. However, we continued to monitor the outcomes of the service improvement actions. We also provided a copy of the undertaking to the Secretary of the DHHS and the Chief Psychiatrist and made a number of systemic recommendations to them about the use of mechanical restraint in EDs.

Please note: names and some details in this complaint story have been omitted to protect the identity of those involved.

Reviewed 21 April 2021

Mental Health Complaints Commissioner

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