Data source and key concepts

Involuntary care quality information

National Residential Mental Health Care Database

Data Quality Statements for National Minimum Data Sets (NMDSs) are published annually on the Metadata Online Registry (METeOR). Statements provide information on the institutional environment, timeliness, accessibility, interpretability, relevance, accuracy and coherence. Refer to the Residential mental health care NMDS 2018–19: National Residential Mental Health Care Database, 2020; Data Quality Statement. Previous years' data quality statements are also accessible in METeOR.

National Community Mental Health Care Database

Data Quality Statements for National Minimum Data Sets (NMDSs) are published annually on the Metadata Online Registry (METeOR). Statements provide information on the institutional environment, timelines, accessibility, interpretability, relevance, accuracy and coherence. Refer to the Community mental health care NMDS 2018–19: National Community Care Database, 2020 Quality Statement. Previous years' data quality statements are also accessible in METeOR.

Seclusion and restraint data quality information

Variations in state and territory legislation may result in exceptions to the definition of a seclusion event as presented in the key concepts section. Data reported by jurisdictions may therefore vary and jurisdictional comparisons should be made with caution. The estimated acute bed coverage for 2018–19 seclusion and restraint data was complete coverage based on acute beds admitted units reported to the Mental Health Establishments National Minimum Data Set in 2018–19.

State and territory specific information is included in the accompanying Data Quality Statement.

Seclusion

High numbers of seclusion events for a few individuals can have a disproportional effect on the rate of seclusion reported. The increases in the state-wide Tasmanian seclusion rate for 2012–13 and 2013–14 data, and for the ACT from 2017–18 to 2019–20 are due to a small number of clients having an above average number of seclusion events.

Restraint

States and territories have different policy and legislative requirements regarding restraint practices and therefore different systems in place for collecting data, and differences in the types of restraint that are reported. Unspecified restraint was reported for 2015–16 to represent combined restraint or when data providers were unable to disaggregate mechanical and physical restraint events.

In addition, the reporting of restraint data is still a relatively novel exercise, with the first release of data occurring in May 2017. It is expected that data quality will improve over time as information systems are refined and definitions are better understood by the sector. As such, caution should be exercised when interpreting this data and comparing results between states and territories and over time.

Frequency and duration

Frequency and duration of seclusion events were collected for the first time in 2013–14. The Australian Capital Territory was unable to provide the number of admitted patient care episodes prior to 2018–19; as such, the national results for the frequency of seclusion during episodes of care up to 2017–18 exclude the Australian Capital Territory and include the Territory for 2018–19 onwards. Duration data for South Australia are excluded from the national average duration from 2013–14 to 2017–18 due to issues with the data recording methodology used in South Australia. South Australia is included in the national average duration for 2018–19 onwards.

Target population

Data presented is the target population of the service unit; that is, the age group that the service is intended to serve, not the age of individual patients. In 2013–14, improvements were made to the reporting of target population categories. The Mixed category was removed as an option for reporting. Data for the Mixed category was most commonly a mix of General, Child and adolescent and/or Older person services. Time series data by target population should therefore be approached with caution. Seclusion and restraint metrics for a small number of Youth hospital beds reported by Victoria, Western Australia, and the Northern Territory are also included in the General category.

Forensic services provide services primarily for people whose health condition has led them to commit, or be suspected of, a criminal offence or make it likely that they will reoffend without adequate treatment or containment. The average duration of a seclusion event is reported excluding Forensic services, as forensic seclusion events are typically of longer duration, and substantially skew the overall duration average.


Restrictive practices key concepts

Key concept

Description

Mental health legal status is defined as whether a person is treated on an involuntary basis under the relevant state or territory mental health legislation, at any time during an episode of admitted patient care, an episode of residential care or treatment of a patient/client by a community based service during a reporting period (METeOR ID 272343).

Restraint

Restraint is defined as the restriction of an individual's freedom of movement by physical or mechanical means.

Mechanical restraint

The application of devices (including belts, harnesses, manacles, sheets and straps) on a person's body to restrict his or her movement. This is to prevent the person from harming themselves or endangering others or to ensure the provision of essential medical treatment. It does not include the use of furniture (including beds with cot sides and chairs with tables fitted on their arms) that restricts the person's capacity to get off the furniture except where the devices are used solely for the purpose of restraining a person's freedom of movement.

The use of a medical or surgical appliance for the proper treatment of physical disorder or injury is not considered mechanical restraint.

Physical restraint

The application by health care staff of ‘hands-on’ immobilisation or the physical restriction of a person to prevent the person from harming themselves or endangering others or to ensure the provision of essential medical treatment.

Seclusion

Seclusion is defined as the confinement of the consumer at any time of the day or night alone in a room or area from which free exit is prevented.

Key elements include that:

  1. The consumer is alone.

  2. The seclusion applies at any time of the day or night.

  3. Duration is not relevant in determining what is or is not seclusion.

  4. The consumer cannot leave of their own accord.

The intended purpose of the confinement is not relevant in determining what is or is not seclusion. Seclusion applies even if the consumer agrees or requests the confinement.

The awareness of the consumer that they are confined alone and denied exit is not relevant in determining what is or is not seclusion. The structure and dimensions of the area to which the consumer is confined is not relevant in determining what is or is not seclusion. The area may be an open area, for example, a courtyard. Seclusion does not include confinement of consumers to High Dependency sections of gazetted mental health units, unless it meets the definition.

More information can be found in the data source section about jurisdictional consistency with this definition.

Target population

Some specialised mental health services data are categorised using 5 target population groups (see METeOR identifier 682403):

  • Child and adolescent services focus on those aged under 18 years.

  • Older person services focus on those aged 65 years and over.

  • Forensic health services provide services primarily for people whose health condition has led them to commit, or be suspected of, a criminal offence or make it likely that they will reoffend without adequate treatment or containment.

  • General services provide services to the adult population, aged 18 to 64, however, these services may also provide assistance to children, adolescents or older people.

  • Youth services target children and young people generally aged 16-24 years.

Note that, in some states, specialised mental health beds for aged persons are jointly funded by the Australian and state and territory governments. However, not all states or territories report such jointly funded beds.