Mental Health Commission Restrictive Practices Report final

The MHC also published a monitoring report this morning that documents the use of restrictive practices across 67 inpatient mental health centres in Ireland in 2022. The report is the fourteenth 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. Mr Farrelly said several positive messages could be taken from the 2022 activity report.
“Overall, in Ireland, the number of restrictive practices continues to decline, and we are encouraged to observe that the number of episodes of physical restraint and the number of residents that are physically restrained have continued to decrease since 2019, countering a previous trend of increase between 2008 and 2018. While there was a 16% increase in seclusion episodes in 2022, the number of patients who were secluded has decreased.”
In 2022, there were a total of 4,309 restrictive practices recorded nationally, which involved 1,653 residents of approved centres. This represented a decrease from 2021, where there was a total of 4,636 episodes, involving 1,803 residents.
In terms of intervention types, there were 2,945 episodes of physical restraint in 2022. This represents a decrease from 3,460 episodes in 2021 (a 15% decrease). A total of 1,078 people were physically restrained in 2022, compared to 1,145 people in 2021 (a 6% decrease).
At a national level, physical restraint is used more frequently and widely than seclusion. Episodes of physical restraint and the number of residents undergoing physical restraint have continued to decrease since 2019.
The use of physical restraint has continued to decline between 2019 and 2022 with respect to the number of episodes, duration of episodes and number of people restrained.
There were 1,364 episodes of seclusion reported by 26 approved centres in 2022, a marginal increase from the 1,176 episodes reported by 27 services in 2021. However, in 2022, 620 people were secluded, a decrease from the 645 people secluded in 2021.
The use of mechanical restraint continues to be rare and the use of this form of restraint continued to decrease in 2022. This practice has also been banned by the MHC in inpatient centres for children.
“The MHC will continue to monitor the use of all forms of restraint to ensure that approved centres operate within the rules and codes of practice. Enhanced reporting requirements, which were rolled out in January 2023, will support closer scrutiny of the activities of approved centres in this area,” said Mr Farrelly.
Due to the international developments around human rights, the advancement of person-centred care, and evidence demonstrating that restrictive practices can have harmful physical and psychological consequences, the MHC in September 2022 published revised rules governing the use of seclusion and mechanical means of bodily restraint, and a revised code of practice on the use of physical restraint, which came into effect on 1 January 2023. These revised rules are informed by a rights-based approach to mental health care and treatment and outline the principles which must underpin the use of restrictive practices, including that all approved centres must recognise the inherent rights of a person to personal dignity and freedom in accordance with national and international human rights instruments and legislation.
“Our revised rules and code of practice sets updated evidenced-based criteria and requires greater oversight by registered proprietors of the use of restrictive practices within their services. We are already seeing evidence that this is having an effect on the further reduction in the use of restrictive practices in 2023,” said Mr Farrelly.