THERE WERE OVER 1,800 people restrained or secluded by mental health services in 2020, according to a new report.

The report, published by the Mental Health Commission (MHC) this morning, shows that there were 1,880 people restrained or secluded across 66 inpatient mental health care centres in 2020.

This is the 11th report by the MHC on restraints or seclusion of people in the care of mental health services.

The MHC have restated their view that there is no evidence of therapeutic benefit associated with either seclusion or restraints and that it should not be seen as a therapeutic practice.

A full review of codes and practices of restraint and seclusion is also being carried out by the MHC, with the process set to be completed by mid-2022.

In total, there were 5,830 episodes of restrictive practices in 2020, which is a decrease from 2019 where there were 6,741 episodes of restrictive practices.

However, there were more people restrained or secluded in 2020 at 1,880, compared to 1,796 people in 2019.

Director of Regulation for the Mental Health Commission, Gary Kiernan, says that the decrease in episodes of restrictive practices is “encouraging”.

“It is encouraging once again to see a reduction in the overall use of restrictive practices in 2020,” said Kiernan.

Overall, the MHC is concerned that there continues to be an upward trend in the use of physical restraint across approved services in Ireland since 2008. Although the number of recorded episodes of mechanical restraint remains low, there was a significant increase in episodes involving a small number of residents in 2020.

“The MHC strongly advocates for the use of de-escalation measures over restrictive practices. For such measures to be successful, it is essential that staff are appropriately trained in de-escalation and in clinical risk management.”

Kiernan says that all healthcare professionals in mental health centres have been trained in prevention, de-escalation and management of violence, and he hopes that increased training levels will help reduce the use of restrictive practices.

Physical restraint

The MHC report shows that there was a 21% decrease in the number of restrictive episodes in 2020, with 3,990 episodes being recorded.

This is a significant drop from 2019, where there were 5,029 episodes of physical restraint.

A total of 1,211 people were physically restrained in 2020, which is a drop of 232 from 2019 where there were 1,443 people physically restrained

Physical restraint was the most common restrictive measure recorded by the MHC in 2020, accounting for 68% of all interventions. This is compared to 75% in 2019.

The practice of physical restrant was used in 73% of healthcare centres in 2020, as opposed to 89% in 2019.

Seclusion

There were a total of 1,840 episodes of seclusion reported in 2020, involving 699 people.

This was an increase on 2019, where there were 1,719 episodes reported in 2019.

The process of seclusion was used in 41% of centres in 2020, with the MHC saying the figure is similar to 2019.

There were 243 episodes of seclusion where a person was secluded for more than 24 hours and 74 episodes where a person was secluded for more than 72 hours in 2020.

Both of these figures are an increase on 2019, where there was 255 episodes and 61 episodes for 24 hours and 72 hours respectively.

The average seclusion time across all mental health centres, excluding the Central Mental Hospital, was 14 hours and 12 minutes. 38% of patients who were secluded were secluded for eight hours or less.

Mechanical restraint

The MHC says that while there were more incidents of mechanical seclusion in 2020 than 2020, the practice remains relatively uncommon.

There were only two centres, the Central Mental Hospital and a child and adolescent centre, that reported using mechanical restraint.

There were 150 episodes in 2020, which lasted for a combined 3,452 hours, involved the use of both hand and leg cuffs.

In 2019, there were only 18 episodes of mechanical restraint that lasted for a total of 34 hours, which is significantly lower than the 2020 figure.