OVER 1,700 PEOPLE were restrained or secluded across mental health services in Ireland last year, according to a new report. 

The Mental Health Commission (MHC) this morning published a report that documents the use of seclusion, physical restraint and mechanical restraint across 65 in-patient mental health centres in 2019. 

The report is the 10th such publication by the MHC and forms part of its remit to report independently on the quality and safety of mental health services in Ireland. 

It shows that there were 6,747 episodes of restrictive practices reported to the MHC in 2019, with 1,796 people being secluded and/or restrained during that time. 

This represents a decrease from 7,464 combined episodes of seclusion and physical restrain, involving 1,999 residents, in 2018. 

“It is encouraging once again to see a transparent reporting culture, and the reduction in the overall use of restrictive practices from 2019 is very welcome,” said the chief executive of the Mental Health Commission, John Farrelly.

However, notwithstanding this, it is also clear that episodes of physical restraint and seclusion are not decreasing at a rate that would suggest that these practices are slowly but surely disappearing from our mental health services.

“Ultimately, we want to reach a position where we only see these practices applied in very limited and exceptional circumstances,” Farrelly said.

Physical restraints

In terms of intervention types, the report revealed an 11% decrease in episodes of physical restraint over a 12-month period, with 5,029 episodes recorded in 2019, compared to 5,665 in 2018.

Physical restraint was used in 89% of centres in 2019, as opposed to 85% in 2018, while 1,143 people were physically restrained in 2019, 64 fewer people than in 2018.

Physical restraint was the most frequently used restrictive intervention.

It was used in most centres and accounted for 75% of all interventions in 2019, compared to 76% in 2018.

Seclusion

Seclusion accounted for 25% of restrictive interventions in 2019, compared to 24% in 2018.

In 2019, 58 centres (89%) reported 5,029 episodes of physical restraint, while 55 centres (86%) reported 5,665 episodes in 2018.

There were 1,719 episodes of seclusion in 2019, a slight decrease from 1,799 in 2018.

The report also noted that seclusion was used in 42% of centres in 2019 – the same percentage as the previous year – and that there were 225 episodes in 2019 where a person was secluded for more than 24 hours (down from 317 episodes in 2018), and 61 episodes where a person was secluded for over 72 hours (down from 81 episodes in 2018).

In contrast, although the use of mechanical restraint was higher in 2019 than in 2018, its use remains very low overall.

Only one centre – the Central Mental Hospital – reported the use of mechanical restraint, with all 18 episodes – which combined lasted just over 34 hours – involving the use of handcuffs.

Historical comparisons

The report also compares data from 2019 with data from the first report by the MHC into the national use of seclusion and restraint for the year 2008. It shows that the combined episodes of physical restraint and seclusion has risen from 4,765 episodes in 2008 to 6,747 in 2019, a 42% increase.

There has been an increase in physical restraint episodes over the 11-year period, from 2,123 in 2008 to 5,028 in 2019.

While there has been a decrease in the number of episodes of seclusion, from 2,642 in 2008 to 1,719 in 2019, 12% of episodes lasted for longer than eight hours in 2008, compared to 39.7% in 2019.

In other words, there were fewer episodes of seclusion in 2019 compared to 2008, but a greater proportion of episodes lasted for longer periods of time.  

Commenting on the specific practices, Farrelly said, “We know there is no evidence of a therapeutic benefit associated with the use of restrictive practices, and limited evidence of them reducing behaviours of violence and aggression.

The fact that we are still using handcuffs to restrain people sends out all the wrong messages and is simply not reflective of what a modern mental health service should look like.

Farrelly confirmed that, starting in 2021, the MHC intends to review and modify the relevant rules and codes of practice in a further effort to reduce episodes of restrictive practices across the country’s mental health services.

As part of their review of the rules and codes of practice governing restrictive practices, the MHC intends to hold a public consultation process and will be seeking input from service users, families, carers, staff, advocacy groups, and the general public.