Roadblocks in mental health practice

Clinical factors stand in the way of better mental health care, according to new research led by Flinders.

The research project led by Professor Eimear Muir-Cochrane, Chair of Nursing (Mental Health) at Flinders University, has found that despite best practice techniques being available to reduce or eliminate seclusion and restraint, national system-wide implementation is inconsistent.

The project, funded by the National Mental Health Commission, and conducted by the Australian College of Mental Health Nurses (ACMHN), reveals that clinical factors stand in the way of achieving a restraint-free environment in mental health care.

“We examined nurse perceptions of barriers and enablers to eliminating seclusion and restraint use in psychiatric inpatient settings and emergency departments,” Professor Muir-Cochrane says.

“Inhibiting factors include insufficient resources; inadequate staffing levels and nurses being time poor and having high workloads. There are also concerns around safety and duty of care.

“I hope the report can be the driver towards a positive change. A collaborative effort from different parties will be required for change to occur,” she says.

The report calls for a national approach that encompasses clinical leadership, greater training, adequate staffing levels and collaboration between mental health services and other health providers, schools, the justice sector

Professor Muir-Cochrane was also recently appointed President of the ACMHN, the peak body for mental health nurses in Australia. She was nominated for the three-year position at the ACMHN annual general meeting, held during the 42nd International Mental Health Nursing Conference in Hobart last month.

During the conference, Flinders University postgraduate student Matthew Ball was also named Mental Health Nurse of the Year 2017.

Professor Eimear Muir-Cochrane became president of the Australian College of Mental Health Nurses (ACMHN) at the 42nd International Mental Health Nursing Conference.

In a previous research study, Flinders mental health nursing researchers explored the perceptions and understandings of health professionals, including nursing, medical and allied health workers, about how chemical restraint is defined and used in adult acute mental health care and emergency departments, as well as the impact of its use.

Professor Muir-Cochrane, Dr Adam Gerace and Deb O’Kane from the College of Nursing and Health Sciences examined the the use of chemical restraint across 12 acute inpatient psychiatric units in South Australia over a 12 month period.

This study found that while the incidence of the use of forced medication was relatively low, of those who experienced it, there were more males (57.5%) than females, with more than 55% of patients having a diagnosis of schizophrenia.

A greater proportion of patients in the 25-34 year age range were being restrained. It was found that restraint use occurred early in consumers’ admissions, and events often occurred at staff changeover and consumer medication and meal times.

During the research study semi-structured interviews and focus groups were held with senior representatives from consumer advocacy groups such as Mental Illness Fellowship of SA, SA Health and Community Complaints Commissioner and the Consumer/Carer Register DOH SA to gain broader perspectives about the use of chemical restraint from advocacy groups and the general public.

“The use of forced medication to control a patient’s behaviour must always be used as a last resort but is necessary in emergencies to guarantee the safety of patients and staff,” Professor Muir-Cochrane said.

Implications and challenges for clinicians working in acute psychiatric inpatient units and other settings such as emergency departments were discussed as part of Flinders Health Research Week 2017.

Coercive measures such as restraint and seclusion are used worldwide in mental health care to manage patients who are deemed a risk to themselves and/or others.

Chemical (pharmaceutical) restraint, where patients are forced or coerced to take psychotropic medication, is one such measure.

Chemical restraint has been described as a highly coercive intervention with deleterious emotional and physical outcomes for consumers.

However, in comparison to other containment practices used in psychiatric inpatient settings (mechanical and physical restraint, seclusion), few studies have investigated the prevalence of chemical restraint use, characteristics of patients who are restrained and features of these events.


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