New report shows significant decline in restrictive practices across Irish inpatient mental health services over past 7 years
The Mental Health Commission (MHC) has published a report demonstrating a significant decline in the use of restrictive practices – such as seclusion and physical restraint – across Irish mental health services in the past seven years.
Authored by the Inspector of Mental Health Services, Professor Jim Lucey, the report shows that the total number of restrictive practice episodes in approved mental health centres has fallen by 62% from 2018 to 2024, while there has been a 91% reduction in seclusion and physical restraint in Child and Adolescent Mental Health Services (CAMHS) over the same period.
Entitled ‘Declining use of restrictive practices in approved centres in Ireland in 2023 and 2024’, the report highlights how steps taken by the Mental Health Commission, and by service providers, to improve quality care through the adoption of a human rights-based approach has accelerated the downward trend in these types of practices.
Welcoming the Inspector’s report, the Chief Executive of the Mental Health Commission, John Farrelly, said: “Our regulatory changes and initiatives, coupled with the commitment of leadership and staff to person-centred, therapeutic care has been instrumental in accelerating the downward trend in restrictive practice use in Ireland since 2022, and building on a significant decline observed since 2018.”
The total number of restrictive practice episodes fell by 34% between 2022 and 2024 and by 62% since 2018. The rate of decline in seclusion episodes in 2023 and 2024 was almost twice that seen in the preceding four years. Similarly, the rate of reduction in the number of people physically restrained between 2023 and 2024 was twice that seen in the preceding four years. This progress is seen as a tangible indicator of progress in human rights-based mental healthcare.
Since January 1, 2023, the MHC banned the use of mechanical restraint on children. The revised Rules and Code of Practice, which came into effect on the same date, have contributed to a notable 80% decrease in seclusion episodes and a 57% decrease in physical restraint episodes in CAMHS approved centres between 2023 and 2024. This accelerates a downward trend observed since 2018, leading to a 91% reduction in seclusion and physical restraint in CAMHS services by 2024.
In his report, Professor Lucey said: “Children are specifically protected from restrictive practices in Irish mental health care through a human rights-based approach, acknowledging their particular vulnerability to trauma and harm from restrictive interventions. Seclusion and physical restraint can have adverse implications for their emotional development. This approach, underpinned by the principles of trauma-informed care, has been further enhanced by the revised regulations.”
“Our report documents a profound decline, showcasing the immense progress we have made by working together with staff in services in protecting a particularly vulnerable group. The total number of restrictive practice episodes in CAMHS fell from 2,608 episodes in 2018 to just 238 in 2024.”
Professor Lucey added: “Approved centres using seclusion or physical restraint on children must conduct a mandatory documented risk assessment for each child by a registered medical practitioner or registered nurse upon admission. This assessment must carefully consider the child's physical status and emotional development and their vulnerability to trauma and harm from restrictive interventions, determining if restraint can be safely used. Physical restraint should be used with extreme caution as their musculoskeletal systems are immature, which elevates the risk of injury.”
The MHC revised its Rules governing the use of seclusion and mechanical restraint and a Code of Practice on the use of physical restraint, both of which came into effect on January 1, 2023. These revisions were developed prioritising the dignity, autonomy, and wellbeing of service users, recognising their inherent rights to personal dignity and freedom. The principles of trauma-informed care also underpin these revised regulatory changes.
This review was prompted by international developments in human rights understanding, advancements in person-centred care, and evidence demonstrating the harmful physical and psychological consequences of restrictive practices.
Mr Gary Kiernan, Director of Regulation at the MHC said: “We have found significant reductions in both the frequency and duration of these practices, particularly since our new regulations and our improved, near real-time reporting system came into effect. Furthermore, the steps we have taken in conjunction with approved centres to achieve these reductions includes mandatory training, new policies, and detailed post-incident reviews, emphasising a shift towards trauma-informed and person-centred care.
“We have also introduced enhanced oversight and reporting, requiring services to report each episode of seclusion or restraint within three working days of its commencement. This near real-time data collection has improved data quality and accuracy. This allows us to monitor usage, conduct risk rating, and perform trend analysis, leading to prompt regulatory interventions like contacting services with high rates of prone restraint or conducting unannounced inspections.
Mr Kiernan continued: “Services are now required to develop and implement a reduction policy, conduct person-centred debriefs with the secluded or restrained person, conduct multidisciplinary team reviews to discuss the incident, identify triggers, missed opportunities, environmental factors, and alternative de-escalation strategies. They also ensure that staff receive appropriate mandatory training in trauma-informed care, cultural competence, human rights, legal principles of restrictive interventions, prevention and therapeutic management of violence and aggression, and positive behaviour supports.”
Professor Lucey concluded: “Our vision extends beyond the current scope of restrictive practices. It is our hope that this human rights approach will be applied more broadly to include all areas of care. It is our long-term goal of fostering a culture that prioritises dignity, autonomy, and wellbeing across all aspects of mental healthcare, not just in the context of restrictive interventions.”
The Mental Health Commission has presented this report to the Health Service Executive, and the Department of Health, for review and consideration.
To access the full report, please follow this link: Declining use of restrictive practices in approved centres in Ireland in 2023 and 2024, Steps taken by the Mental Health Commission and by service providers to improve quality care through the adoption of a human rights-based approach Full Report.
