Restrictive interventions

The Act provides for and regulates the use of restrictive interventions on a person who is receiving mental health and wellbeing services in a designated mental health service.

This means that if restrictive interventions are used on a person in these settings, they must be authorised, monitored and reported in accordance with the Act. This is regardless of whether or not the person is subject to an order authorising compulsory assessment or treatment.

Restrictive interventions include seclusion, bodily restraint and chemical restraint.

Seclusion

Seclusion means the sole confinement of a person to a room or any other enclosed space from which the person cannot leave.

Bodily restraint

Bodily restraint means:

• physical restraint – the use by a person of their body to prevent or restrict another person's movement. Physical restraint does not include the giving of physical support or assistance to a person in the least restrictive way that is reasonably necessary to enable the person to be supported or assisted to carry out daily activities; or to redirect the person because they are disoriented; or
• mechanical restraint – the use of a device to prevent or restrict a person’s movement.

Chemical restraint

Chemical restraint means the giving of a drug to a person for the primary purpose of controlling the person's behaviour by restricting their freedom of movement. Chemical restraint does not include the giving of a drug to a person for the purpose of treatment or medical treatment.

Reducing the use of restrictive interventions

The Act includes an objective with an aim of reducing the use of restrictive interventions with the aim of eliminating their use within 10 years.

There is an obligation on all mental health and wellbeing service providers and people performing functions or exercising powers under the Act to aim to reduce, and eventually eliminate the use of restrictive interventions.

To support this goal, the Act includes a function for the Secretary and Chief Officer to set targets to reduce and ultimately eliminate the use of restrictive interventions. This will be supported through a strategy towards elimination of seclusion and restraint being led out of the Department of Health.

Authorising the use of restrictive interventions

A restrictive intervention may only be authorised if it is the least restrictive option

A restrictive intervention may only be used after all reasonable and less restrictive options have been tried or considered and found to be unsuitable in the circumstances.

To determine if there is no less restrictive option available, a person authorising the use of restrictive interventions must have regard, to the greatest extent possible in the circumstances to:

• the likely impact of the use of the restrictive intervention on the person, considering the person’s views and preferences, and any past experience of trauma;
• the person’s views and preferences relating to the use of restrictive interventions (including views and preferences expressed in an advance statement of preferences of the person or expressed by the person’s nominated support person, if they have one); and
• the person’s culture, beliefs, values and personal characteristics.

A restrictive intervention may only be authorised when necessary

A restrictive intervention may only be used where necessary to prevent serious and imminent harm to the person or another person.

Bodily restraint may also be used where necessary to administer treatment or medical treatment.

Chemical restraint may also be used in defined circumstances when a person is being transported under the Act.

Decision making principles for treatment and intervention

A person authorising the use of restrictive interventions must give proper consideration to the decision-making principles for treatment and interventions.

Responsibility for authorising restrictive interventions

The use of restrictive interventions must be authorised by an authorised psychiatrist.

If an authorised psychiatrist is not reasonably available:

• seclusion or bodily restraint may be authorised by – a registered medical practitioner or a nurse in charge ; and
• chemical restraint may be authorised by – a registered medical practitioner or a nurse practitioner acting within their ordinary scope of practice.

If a person other than an authorised psychiatrist authorises the use of a restrictive intervention, that person must, as soon as practicable, notify the authorised psychiatrist.

Authorisation for the use of restrictive intervention must end if no longer necessary

The authorisation for the use of restrictive interventions must be kept under review.

The authority to use a restrictive intervention ends if a person who may authorise the use of restrictive interventions is satisfied that the restrictive intervention is no longer necessary for the purpose for which it was authorised. If this occurs, that person must immediately take steps to release the person from the restrictive intervention.

Urgent authorisation of physical restraint by a nurse

If physical restraint of a person is necessary to prevent imminent and serious harm to that person or another person, and an authorised psychiatrist, registered medical practitioner or nurse in charge is not immediately available a registered nurse may authorise the use of physical restraint.

A registered nurse who authorises the urgent use of physical restraint must notify the authorised psychiatrist, registered medical practitioner or nurse in charge as soon as practicable. Once notified, if the physical restraint is continuing, the person notified must either:

• authorise the continued use of physical restraint; or
• refuse to authorise continued use and release the person from restraint.

Monitoring and support of a person subject to restrictive interventions

Facilities and supplies to be provided

A person who is subject to a restrictive intervention must be provided with facilities and supplies that meet their needs and maintain their dignity.

It is the responsibility of the person who authorises the use of restrictive intervention to ensure this occurs. In determining what facilities and supplies are to be provided, regard must be had, to the greatest extent possible in the circumstances to:

• the person’s views and preferences and any past experience of trauma
• the person’s views and preferences relating to the use of restrictive interventions (including views and preferences expressed in an advance statement of preferences of the person or expressed by the person’s nominated support person, if they have one)
• the person’s culture, beliefs, values and personal characteristics.

Monitoring

The Act sets out requirements for the monitoring, clinical review and examination of a person while restrictive interventions are being used on them.

Continuous observation

When bodily restraint is used on a person, they must be continuously observed by a registered nurse or registered medical practitioner for the entire time of the restraint.

When chemical restraint is used on a person, they must be continuously observed by a registered nurse or registered medical practitioner for at least an hour after the chemical restraint is administered.

Clinical review

When any restrictive intervention is used on a person, a registered nurse or registered medical practitioner must clinically review the person at least every 15 minutes, or more frequently if appropriate given the person’s condition.

Examination

When an authorised psychiatrist authorises or is notified of the use of restrictive intervention on a person, the authorised psychiatrist must, as soon as practicable, examine the person and determine if continued use of restrictive interventions is necessary.

If the authorised psychiatrist is not reasonably available to examine the person, the authorised psychiatrist must ensure that the person is examined by a registered medical practitioner. The registered medical practitioner must determine if continued use of restrictive interventions is necessary.

The authorised psychiatrist must then conduct an examination of the person as often as is appropriate, which must be at least every four hours. If an authorised psychiatrist is not practicably able to conduct an examination, a registered medical practitioner may do so when so directed by the authorised psychiatrist.

Documentation and notifications of the use of restrictive interventions

Documentation

As soon as practicable after authorising the use of a restrictive intervention, the person who authorised the use must document –

• the reasons why the restrictive intervention is necessary; and
• all the other less restrictive means tried or considered for the person and why those less restrictive means were found unsuitable.

Notification of the non-legal mental health advocacy service provider

An authorised psychiatrist must ensure the non-legal mental health advocacy service provider is notified as soon as practicable after the commencement of the use of a restrictive intervention on a person. The notification to the non-legal mental health advocacy service provider must be made in accordance with the protocols issued by the Chief Officer. These Protocols will be published on the Department of Health website once finalised.

Notification of others

As soon as practicable after the commencement of the use of a restrictive intervention on a person, the authorised psychiatrist must ensure that specified associated people are notified of the use of restrictive intervention, the nature of the intervention and the reason for its use.

The associated people to be informed about the making of a temporary treatment order are the person’s:

• nominated support person, if they have one
• guardian, if they have one
• carer, if the authorised psychiatrist is satisfied that the restrictive intervention will directly affect the carer and the care relationship
• a parent, if the person is under the age of 16 years.

The requirements for communicating under the Act must be followed.

The authorised psychiatrist must also ensure all reasonable steps are taken to notify the Secretary to the Department of Families, Fairness and Housing if the Secretary has parental responsibility for the person under a relevant child protection order.

Review of the use of restrictive interventions

As soon as practicable after the use of a restrictive intervention ends, the authorised psychiatrist must ensure that the use of the restrictive intervention is reviewed, with the review to be completed in a timely manner.

The person on whom the restrictive intervention was used must be offered an opportunity to participate in this review. If the person accepts that offer, they may have their nominated support person, a mental health advocate a family member, carer or other supporter participate in the review.

Reporting on the use of restrictive interventions

The authorised psychiatrist of a designated mental health service must provide written reports to the chief psychiatrist on the use of restrictive interventions in the designated mental health service. The report must contain the details required by and be provided within the time specified by the chief psychiatrist.

Chemical restraint during transport

Chemical restraint may be used on a person by a registered medical practitioner (or a registered nurse or registered paramedic employed by Ambulance Victoria acting on direction of a registered medical practitioner) for the purpose of transporting the person to or from a designated mental health service or any other place under the Act.

Existing powers of a registered nurse or registered paramedic to administer sedation within the ordinary scope of their practice are not changed by the Act.

Transitional arrangements

Bodily restraint or seclusion authorised prior to 1 September 2023 will be taken to be bodily restraint or seclusion authorised under the Mental Health and Wellbeing Act 2022.