The Royal Commission into Victoria’s Mental Health system presented what a reimagined mental health system could look like, and how it would support the mental health and wellbeing of Victorians for years to come. The current system means that staff have no option but to view restraint and seclusion as 'inevitable' to ensure their own safety. Like consumers, staff also experience distress in using seclusion and restraint.
The Royal Commission identified the need to reduce restrictive interventions as one of the key priorities for the Mental Health Improvement Program (MHIP), in addition to reducing compulsory treatment, preventing gender-based violence, and preventing suicides in mental healthcare settings. This collaborative is our recognition of the importance of the work and our commitment to ensuring the very best mental health system for all Victorians.
We're looking to build on expertise and existing improvement efforts across Victoria to accelerate the implementation of best practice in the mental health system. The Safety for all: Towards elimination of restrictive practices - Breakthrough Series Collaborative will further test and spread the success of evidence-based models of care to reduce restrictive interventions. This is an opportunity for Victorian hospitals seeking to embed evidence-based change ideas that improve how consumers are managed on inpatient mental health wards.
We aim to reduce the use of restrictive practices in mental health inpatient units by 20 per cent in participating services by April 2024. The Mental Health Act 2014 (Vic) currently defines two forms of restrictive interventions:
- bodily restraint - a form of physical or mechanical restraint that prevents a person having free movement of their arms or limbs but does not include the use of furniture (including beds with cot sides and chairs with tables fitted on their arms) that restricts the person’s ability to get off the furniture
- seclusion - the sole confinement of a person to a room or any other enclosed space from which it is not in the control of the person confined to leave.
Under the Act, seclusion and restraint can only be used in designated mental health services. The Act also prescribes that restrictive interventions, including seclusion and restraint, may only be used after 'all reasonable and less restrictive options have been tried or considered and have been found to be unsuitable'. Restrictive interventions can also be referred to as 'restrictive practices'.
How this will be accomplished
A breakthrough series (BTS) collaborative structure (Figure 1) will be used to test and implement evidence-based change ideas to accomplish a common aim. This involves three in-person learning sessions (or equivalent virtual sessions), and three health service-based action periods, where changes are tested and adopted, adapted or abandoned. Teams maintain continual contact with each other and SCV through web calls, online discussions, email, and monthly progress reports.
We will support participating health services to:
- actively work to develop, improve and/or spread ideas and approaches
- measure progress of their efforts and use data to drive improvement
- foster shared learning and collaboration with others across Victoria
- apply Quality Improvement tools, methods, and resources to improve daily work, sustain change, and spread.
These learned skills are applicable to any project.
The collaborative will run from August 2022 – April 2024.Figure 1: The Breakthrough series collaborative model