Seclusion and Restraint: Rethinking Regulation from a Human Rights Perspective

Abstract

This article examines a number of options for regulating seclusion and restraint in Australia in light of international human rights standards and comparative international approaches. While seclusion and restraint can sometimes be beneficial for the protection of individuals, these practices can also cause serious psychological and physical harm. It is therefore necessary to reconcile any need for the use of seclusion and restraint with the risks associated with their practice. This article proposes that regulation should occur via a combination of detailed legislation and codes of practice.

Key words:

• human rights
• regulation
• restraint
• seclusion

Notes

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 2. Mental Health Act 2009 (SA), s 7.

 3. Mental Health (Treatment and Care) Act 1994 (ACT) s 35, Mental Health and Related Services Act 1998 (NT) ss 61–62, Mental Health Act 2000 (Qld) ss 141–160; Mental Health Act 1996 (Tas) ss 34–36; Mental Health Act 1986 (Vic), ss 81–82; Mental Health (Compulsory Assessment and Treatment) Act 1992 (NZ) s 71(2) (dealing with seclusion only). See in general: Janine McIlwraith and Bill Madden, Health Care & The Law (5th edn Thomson Reuters, Sydney 2010) 99–104 and 161–64; I Freckelton, ‘Mental Health Law’ in F McDonald, B White and L Wilmott (eds), Medical Law in Australia (Thomson/Reuters, Sydney 2010 in press); Sylvia Bell and Warren Brookbanks, Mental Health Law in New Zealand (2nd edn Thomson Brookers, Wellington 2005) 201–222.

 4. New South Wales Health, ‘Policy Directive: Policies on Seclusion Practices, the Use of Restraint and the Use of IV Sedation in Psychiatric Inpatient Facilities’ (July 2007) <http://www.health.nsw.gov.au/policies/pd/ 2007/pdf/PD2007_054.pdf>, accessed 28 April 2010, New Zealand Ministry of Health, Procedural Guidelines for the Use of Seclusion (revised edn, Wellington June 1995).

 5. NMHSRP (n 1).

 6. The National Mental Health Consumer and Carer Forum, ‘Ending Seclusion and Restraint in Australian Mental Health Services’ (2009) <http://www.nmhccf.org. au/documents/NMHCCF%20Secl&Rest. pdf> 7, accessed 28 April 2010.

 7. Convention on the Rights of Persons with Disabilities (adopted 13 December 2006, opened for signature 30 March 2007, entered into force 3 May 2008) 46 ILM 443 – signed by Australia 30 March 2007 and ratified 17 July 2008.

 8. NMHSRP (n 1).

 9. NMHSRP (n 1).

10. NMHSRP (n 1).

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18. Muir-Cochrane (n 17) 16.

19. Muir-Cochrane (n 17) 16.

20. Eimear Muir-Cochrane, Colin Holmes and Jo Ann Walton, ‘Law and Policy in Relation to the Use of Seclusion in Psychiatric Hospitals in Australia and New Zealand’ (2002) 13 Contemporary Nurse 136, 137.

21. Muir-Cochrane et al (n 20) 137.

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23. Peter Bartlett and Ralph Sandland, Mental Health Law Policy and Practice (3rd edn Oxford University Press, New York 2007) 338.

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25. Stacey Tovino, ‘Psychiatric Restraint and Seclusion: Resisting legislative Solution’ (2007) 47 Santa Clara Law Review 511, 534.

26. Tovino (n 25) 534.

27. Tovino (n 25) 537.

28. Bartlett and Sandland (n 23) 337.

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35. Staudenmaier (n 34) 153.

36. Convention on the Rights of Persons with Disabilities (n 6).

37. Convention on the Rights of Persons with Disabilities (n 6).

38. Tovino (n 25) 535.

39. Tovino (n 25) 540.

40. Muir-Cochrane (n 17) 16.

41. Bartlett and Sandland (n 23) 340.

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46. Foster et al (n 45) 147.

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49. Bartlett and Sandland (n 23) 344.

50. Larson et al (n 16)198.

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61. Convention for the Protection of Human Rights and Fundamental Freedoms (opened for signature 4 November 1950, entered into force 3 September 1953) 213 UNTS 222.

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63. Peter Bartlett, Oliver Lewis and Oliver Thorold, Mental Disability and the European Convention on Human Rights (Koninklijke Brill NV, Leiden 2007) 96–97.

64. Tilman Steinert and Peter Lepping, ‘Legal Provisions and Practice in the Management of Violent Patients. A Case Vignette Study in 16 European Countries’ (2009) 24 European Psychiatry 135, 137.

65. For a detailed discussion of the case law on seclusion in England and Wales, see P Fennell, ‘Institutionalising the Community: The Codification of Clinical Authority and the Limits of Rights-Based Approaches’ in B McSherry and P Weller, Rethinking Rights-Based Mental Health Laws (Hart Publishing, Oxford 2010, in press).

66. House of Lords, House of Commons Joint Committee on Human Rights, ‘Fourth Report of Session 2006–7: Legislative Scrutiny: Mental Health Bill’ HL 40/HC 288 (2007) [102]–[106].

67. National Institute of Clinical Excellence, Violence: The Short-term Management of Disturbed/Violent Behaviour in In-patient Psychiatric Settings and Emergency Departments CG 25 (Royal College of Nursing, London 2005).

68. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment, ‘The CPT Standards’ CPT/Inf/E (2002) 1 – Rev. 2004, established under Article 1 of the European Convention for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (1987) <http://www.cpt.coe. int/en/about.htm> accessed 28 April 2009.

69. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (n 68).

70. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (n 68) Standard 47.

71. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (n 68) Standard 47.

72. Bartlett et al (n 61) 97.

73. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (n 68) Standard 47.

74. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (n 68) Standard 47.

75. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (n 68) Standard 48.

76. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (n 68) Standard 48.

77. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (n 68) Standard 48.

78. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (n 68) Standard 49.

79. European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment (n 68) Standard 49.

80. Gerard Niveau, ‘Preventing Human Rights Abuses in Psychiatric Establishments: the Work of the CPT’ (2004) 19 European Psychiatry 146, 147.

81. Niveau (n 80).

82. Niveau (n 80).

83. Niveau (n 80) 150.

84. Niveau (n 80) 150.

85. Niveau (n 80) 150.

86. Niveau (n 80) 150.

87. Niveau (n 80) 150.

88. Niveau (n 80) 150.

89. Mental Welfare Commission for Scotland, ‘The Use of Seclusion: Guidance on Good Practice’ (2007) <http://www.mwcscot. org.uk/web/FILES/Publications/Seclusion. pdf> accessed 28 April 2010.

90. NMHSRP (n1).

91. NMHSRP (n1).

92. See, for example, Mental Welfare Commission for Scotland (n 89).

93. NMHSRP (n1).