Restrictive interventions in an adult psychiatric inpatient unit: A retrospective analysis following the implementation of the mental health and wellbeing act 2022
AI Summary
Most restrictive interventions were physical restraint (66.7%) and seclusion (32.3%); 300 episodes recorded, medication used in 54% of episodes, often intramuscularly.
Threatened or actual violence was the common precipitant; psychotic and bipolar disorders independently increased odds of exposure to restrictive interventions.
RI exposure associated with substantially longer admissions and underscores the need for consistent reporting and targeted strategies to reduce RIs following MHWA implementation.
Australas Psychiatry. 2026 Jun 3:10398562261455765. doi: 10.1177/10398562261455765. Online ahead of print.
ABSTRACT
BackgroundRestrictive interventions (RIs), including seclusion, physical and chemical restraint, remain controversial in psychiatric care. In Victoria, Australia, the Mental Health and Wellbeing Act 2022 (MHWA) strengthened expectations to reduce RIs.ObjectiveTo examine RI use in an adult acute psychiatric inpatient unit during the first year of the MHWA implementation.MethodA retrospective cohort study was conducted using routinely collected data (1 September 2023-31 August 2024). Patients with at least one RI (n = 66) were compared with patients without RI exposure (n = 66). Group comparisons and logistic regression examined factors associated with RI exposure.ResultsThree hundred RI episodes were recorded, predominantly physical restraint (66.7%) and seclusion (32.3%). Medication was administered in 54% of RI episodes, most often intramuscularly. Threatened or actual violence was the most frequent precipitant. Primary psychiatric diagnosis was independently associated with RI exposure, with psychotic and bipolar disorders showing increased odds. RI-exposed patients had longer admissions (median 23.5 vs 9 days, p < .001).ConclusionsRIs were primarily used in response to acute behavioural escalation associated with severe mental illness. These findings provide an early description of RI use following MHWA implementation and highlight the importance of consistent reporting and strategies to reduce RIs.
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