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Restrictive practices in health settings

The use of restrictive practices in hospitals and health care facilities, residential aged care and disability care settings is a key human rights issue in Australia. The inappropriate use of restrictive practices is concerning because it can cause physical and psychological harm to the person being restricted. It can constitute both a breach of the law and a breach of a person’s human rights.

Common types of restrictive practices include:

  • Detention (e.g. locking a person in a room)
  • Seclusion (e.g. locking a person alone in a room for a limited period of time)
  • Physical restraint (e.g. clasping a person’s hands or feet to stop them from moving)
  • Mechanical restraint (e.g. tying a person to a chair or bed)
  • Chemical restraint (e.g. giving a person a sedative)
  • Electronic restraint (e.g. using tracking bracelets, camera surveillance, restrictions on media devices).

There is no legal framework in Queensland to permit the lawful use of restrictive practices in Queensland public hospitals or other Queensland Health-operated facilities. In the absence of a legal framework, the use of restrictive practices in health settings is potentially unlawful.

Queensland’s Guardianship and Administration Act 2000 and the Disability Services Act 2006 regulate the use of restrictive practices in relation to people with disability. The Mental Health Act 2016 also includes limited restrictive practices provisions which apply to people detained under that Act. There is no such regulation or legal framework that applies to the broader health system.

The Public Advocate recognises that some people experiencing physical or mental illness or cognitive disability may, on occasion, need to be restrained to protect themselves or others from harm. However, an appropriate legal framework is required for such practices to be legally undertaken (except in limited emergency circumstances).

The National Safety and Quality Health Services Standards introduced a new standard in 2020 that requires hospitals to have policies and procedures dealing with the use of restraint and seclusion, including that their use be minimised, and eliminated where possible.

The Public Advocate has used the new standard as a starting point to commence discussions with the Queensland Health Minister and Queensland Health regarding the lawful use of restrictive practices in these settings. These discussions are ongoing.

The Public Advocate has also recently released a restrictive practices reform options paper for Queensland, which proposes the use of a senior practitioner authorisation model across all settings (including health care facilities) where restrictive practices are used in Queensland.

You can read this paper here.