In this symposium we will discuss least restrictive practice in the context of acute mental health inpatient care. The Queensland Mental Health Commission commissioned our team to undertake a project regarding least restrictive practices in acute mental units in Queensland. This project was commissioned in light of a decision on December 15 2013 by Queensland Health to introduce a policy that required the main entry and exit doors to all acute mental health inpatient units throughout the State to be locked. The stated purpose of the new policy is to prevent absconding of involuntary patients and thus reduce the risk of self-harm and harm to others. In this context, voluntary patients and involuntary patients with leave entitlements would maintain their right to leave the ward, but wards would be locked as a universal precautionary measure.

The purpose of this project was to provide a review of the literature on the elements (e.g., legislation, leadership, governance, human resources, workforce, education, training, funding, physical infrastructure, policies, programs, practices and processes) necessary to move towards a least restrictive environment in acute mental health inpatient units in Queensland, particularly in relation to the debate about locked or unlocked facilities. A second aim of the project was to facilitate discussion with consumers, families, carers, support persons and mental health service providers regarding the extent to which those system elements are in place in Queensland.

This symposium aims to provide delegates with an understanding of current literature and evidence, as well as presenting and discussing our research findings, in particular the perspectives of participants and the recommendations we were able to formulate based on the literature review and consultations.

Individual Presentations (30 minutes followed by an expert panel discussion):

1. Brief overview/introduction to our project
This short presentation will outline the methodology for our project; Phase one of the project resulted in a literature and policy review report that included recommendations for the delivery of least restrictive recovery-oriented care in Queensland mental health wards. Phase two involved the project team conducting consultations in an urban and regional location with a groups of people with lived experience, family and carers and staff in each location, co facilitated by consumer and carer researchers .

2. Locking the doors of inpatient units. Evidence, implications and impact

The research literature regarding locked acute mental health units is sparse often with contradictory results. This presentation will highlight some of the more recent literature about the impact of locked doors on Recovery Oriented Practice. The tension between the current locked door policy, research evidence and feedback from consumers, carers and staff who are experiencing the locked units will be discussed.

3. Recommendation for reducing restrictive practices in acute mental health wards

The culmination of this research was the recommendations that were developed by the research team after reviewing the literature. The final recommendations were developed through a consultation process with consumers, carers, and staff of acute mental health units in Queensland. This presentation will outline the consultation process taken and how this process impacted upon the recommendations. We will discuss the consultations and the adjustments were made to the recommendations in light of the consultation findings and options for the future will be provided. These findings were then used by the Queensland Mental health commission (QMHC) to contribute to a paper on options for reform

4. Panel discussion (30 minutes) – including consumer, carer, services provider, QMHC and researcher perspectives and discussion regarding system change

During this panel discussion people with various roles in the project will discuss their experiences and learning and it will be an opportunity for further discussion. It is anticipated that although this research was undertaken in Queensland it will be relevant to the mental health community across Australia and New Zealand

SOMETHING TO SHOUT ABOUT! (scripted drama)
Today people are still confined in isolation within psychiatric care. How is it possible for us to challenge discrimination and promote wellbeing whilst we undermine the human dignity of people with lived experience of mental distress?

This interactive workshop begins with a 5 minute drama performed by the presenter where the central character has just emerged from a day in seclusion. The drama highlights the inequities of the relationship between the service user and mental health worker, and shows the complex responses that test our beliefs about the reality of best practice.

An interactive group process guides the participants through a discussion and activities session to reflect on how our attitudes and judgement convey discrimination that we may not even be aware we display.

SOMETHING TO SMILE ABOUT (scripted drama)
A concluding 3 minute drama performed by the presenter provides an alternative that exposes the central character’s own stigma, whilst at the same time showing that innovative practice can occur in a more humane environment in conjunction with a powerful new peer workforce.
(scripts available on request)