Elimination of restrictive interventions: Is it achievable under the current mental healthcare landscape?

The 2021 release of the report from the Royal Commission into Victoria's Mental Health System suggested 65 recommendations to improve a mental healthcare system that was described as "broken". Several of these recommendations relate to the use of restrictive interventions, such as restraint (both physical and mechanical) and seclusion. These interventions continue to be used in Victorian inpatient mental health facilities today, often in response to aggression and violence towards staff, visitors, family and other consumers. Several health services have committed to the substantial reduction or elimination of the use of restrictive interventions. In this perspective paper, we argue that significant investment is required to achieve this goal. Pressure on mental health nursing staff to cease using restrictive interventions without viable alternatives to de-escalation, restrictions in the built environment, workforce constraints and a lack of education provided early in nursing careers need to be addressed before we can achieve the elimination of restrictive interventions. We recommend that substantial investment in mental health inpatient units, the mental health nursing workforce, and a systemic shift in the role of the mental health nurse are required to attain sustained reduction and potential elimination of restrictive interventions.