Restrictive practices (restraint and seclusion) in the disability, aged care, health, and mental health sectors

The problem: Restrictive practices (including seclusion and restraint) are seemingly intransigent problems across a range of sectors that support vulnerable members of our society, receiving specific mention in Acts of Parliament and focus in recent Royal Commissions. "Restrictive practices can result in serious physical and psychological harm and, in some cases, death. Restrictive practices have been identified as a problem in aged care in Australia for more than 20 years." Aged Care Royal Commission Final Report, 2021, p.68. “…the use of restrictive practices for people with disability can present serious human rights breaches.” NDIS Act, 2013, p.5. Restrictive practices are seen as a failure in care that must be limited. “…seclusion and restraint are ‘not evidence-based therapeutic interventions’ but rather are ‘commonly associated with human rights abuses’, ‘cause short- and longterm emotional damage to consumers’ and overall ‘demonstrate a failure in care and treatment when they are used’..” National Mental Health Consumer and Carer Forum, 2009, p.7 The World Health Organisation (WHO) has identified that measurement and recording of health interventions is essential, and has recently developed the International Classification of Healthcare Interventions to facilitate this. However, restrictive practices have been omitted from this United Nations classification family as they were not viewed as a health intervention. The unfortunate consequence of this is that there are no WHO endorsed definitions or classification taxonomy available to underpin measurement approaches necessary to help address the problem of use of restrictive practices. In Australia, different sectors and jurisdictions use different approaches to define, classify and measure use of restrictive practices, meaning that data cannot be compared and learnings shared across sectors. The urgent need to develop consistent approaches within sectors, let alone between sectors, has been highlighted. "There should be a nationally consistent approach to the regulation of restrictive practices.” Australian Law Reform Commission, Elder Abuse – A National Legal Response (p.93) The solution: We propose a program of research that seeks to: 1. Derive a common definition set for restrictive practices that can be used across sectors. 2. Develop a classification taxonomy to enable measurement of restrictive practices. 3. Evaluate approaches to implement the classification taxonomy in different sectors so that we can be sure that we are going to be feasibly collecting valid and reliable data. The impact: Completion of this work will enable restrictive practices to be accurately measured across sectors, enabling valid evaluation of the success of new policies, procedures, and other restrictive practice reduction strategies, while also enabling learnings to be shared across jurisdictions and sectors to benefit a range of vulnerable populations. The process: Our team seeks to undertake an intentional, co-production process working with stakeholders with responsibility for regulation of restrictive practices across sectors (ie. Australian Commission on Safety and Quality in Health Care, NDIS Quality and Safeguards Commission, National Mental Health Commission, Aged Care Quality and Safety Commission). It will also engage agencies responsible for data management (ie. the Australian Bureau of Statistics), health services, health practitioners, care givers and consumer representatives. Stage 1: Scope, systematically review, and synthesise current activities, definitions, classification systems and measurement approaches across the aged care, disability, health and mental health sectors. Stage 2: Use information gathered in Stage 1 as a part of group consensus-building techniques (ie. Delphi panels and citizen juries) to build consensus definitions and classification taxonomies. Stage 3: Develop and test approaches for measurement of restrictive practices so that end-users can accurately, reliably and feasibly apply the classification taxonomy in their clinical context. This will be conducted across disability, health, aged care and mental health care sectors. This project will focus on Stage 1.