Public Consultation

The MHC is holding a public consultation process to inform:

1. the development of a Code of Practice on the use of pharmacological restraint in inpatient mental health services and

2. the revision of the MHC’s Seclusion and Restraint Reduction Strategy 2014

Background

At present, the MHC regulates 67 approved centres providing inpatient care and treatment to people with a mental health difficulty. As part of its regulatory remit, the MHC currently inspects against rules governing the use of seclusion and mechanical restraint, and a code of practice on the use of physical restraint. The MHC’s rules and code of practice adopt a human rights and person-centred approach to the regulation of these practices. 

The number of episodes of seclusion and physical restraint has been decreasing in approved centres in Ireland since 2018. The rate of decline accelerated following the implementation by the MHC of revised, human rights-based rules and code of practice which came into effect on 1 January 2023. The number of episodes of seclusion and physical restraint has fallen by 62% since 2018, with a notable 91% decrease in the use of these restrictive practices on children[i]. The use of mechanical restraint continues to be very rare. 

Mental Health Bill 2024  

Under the Mental Health Bill 2024, the MHC will be obliged to regulate the use of seclusion, physical restraint, mechanical restraint, and, for the first time, pharmacological restraint in inpatient mental health services. The Bill states that these interventions must only be used:  

• in rare and exceptional circumstances, 
• where there is no safe alternative for the person, 
• where it is the least restrictive practice possible in the circumstances, 
• where it is proportionate to the immediate threat of serious harm to the person or to another person, and 
• for the shortest duration possible.  

Code of Practice on the use of pharmacological restraint

Following the December 2025 amendments to the Mental Health Bill 2024 which aim to expand the MHC’s remit to provide for the regulation of pharmacological restraint (previously referred to as ‘chemical restraint’), the MHC is currently in the early stages of developing a Code of Practice on the use of pharmacological restraint. It is envisaged that this new code of practice will be inspected against from 1 January 2027.   

Section 33(3)(e) of the 2001 Act (the current legislation) provides for the MHC to “prepare and review periodically, after consultation with such bodies as it considers appropriate, a code or codes of practice for the guidance of persons working in the mental health services”. The Code of Practice on the use of pharmacological restraint will be applicable to all inpatient mental health services (“approved centres”) in the public, voluntary and independent sectors including services for children and adolescents, adults, older persons, persons with an intellectual disability and a mental health difficulty and forensic mental health services.   

The Code of Practice will pave the way for requirements which come into effect following enactment of the Mental Health Bill 2024. 

Definition 

The Mental Health Bill defines ‘pharmacological restraint’ as:  

the administration of medication to a person where the only purpose of such administration is to—  

(a) control the person’s behaviour, or  

(b) restrict, prevent or limit the person’s freedom of movement or access to his or her own body,  

but does not include the administration of medication that is for the purposes of treating or   

ameliorating his or her mental disorder”.  

Note: 

It is acknowledged by the MHC that the use of pharmacological restraint is a complex matter which requires careful consideration of human rights, The Code of Practice on the use pharmacological restraint will relate to the administration of medication to control the person’s behaviour, or restrict, prevent or limit the person’s freedom of movement. Whilst the MHC does not support the routine use of pharmacological restraint, it recognises that, in exceptional circumstances and as an emergency measure where there is an immediate threat of serious harm to the person or to another person, its use may be unavoidable. The use of pharmacological restraint should be proportionate to the immediate threat, be the least restrictive practice possible in the circumstances, for the shortest duration possible and where there is no safe alternative for the person.  

The MHC does not have an oversight role in the prescribing of medications as this is a matter of clinical decision-making and is outside the scope of the Code of Practice. However, the MHC recognises that the use of medication to control behaviour or restrict a person’s movement in an emergency is a significant intervention, which has potentially serious consequences for the person. Therefore, the Code of Practice will seek to ensure that its use has robust oversight, the human rights of the person are upheld, and the restraint is undertaken with the most extreme caution with the safety of the person during and after the restraint paramount.   

Revision of the existing Seclusion and Restraint Reduction Strategy 

In light of the Mental Health Bill 2024 and following successful efforts by approved centres to reduce the use of restrictive interventions in recent years, the MHC considers it timely to revise its Seclusion and Restraint Reduction Strategy which was published in 2014. The 2014 strategy aimed to provide services with a list of evidence-based actions that have been demonstrated to assist in efforts to reduce the use of seclusion and restraint. Structured around eight interrelated themes (leadership, engagement, education, debriefing, data, environment, regulation, and staffing), it marked a significant step in promoting a least-restrictive approach in Irish services. The 2014 strategy has also helped to embed the core values of collaboration, rights-based care, and trauma-informed approaches to underpin the reduction and elimination of restrictive practices. Seclusion-and-Restraint-Reduction-Strategy.pdf  

The MHC has identified the need to update the strategy based on updated research and developments in modern mental healthcare such as the move towards more person-centred and trauma-informed care. The revised strategy will focus on the continued reduction and elimination of key practices of concern such as seclusion and physical restraint. It will also seek to minimise the use of unregulated restrictive practices which can often remain hidden but have significant impacts on service users’ liberty, dignity and autonomy and may undermine trust in therapeutic relationships. Examples include constant/one-on-one observation, environmental restraint (e.g. the routine locking of doors and/or buildings), and other blanket restrictions such as set meal times and schedules which are not reflective of the needs of people who use services. 

Purpose of the public consultation

The purpose of these surveys is to help the MHC to identify key areas that the Code of Practice and revised strategy should address.   

As part of this consultation, we would like to hear from all relevant stakeholders. We especially want to hear from people who have experience of using mental health services in Ireland, those close to them, and staff who work in mental health services.   

We will carefully assess all responses received and use the information gathered, along with other available evidence (including an in-depth evidence review and advice received from the Expert Advisory Group and the MHC’s Stakeholder Forum), to develop the code of practice and revise the strategy. The MHC will publish a consultation report alongside the code of practice and revised strategy. 

You can complete the survey by clicking on the below links:

Survey One Link

Development of the code of practice on the use of pharmacological restraint

Survey Two Link

Revision of the MHC’s Seclusion and Restraint Reduction Strategy

While we encourage respondents to complete the surveys using the online forms, completed surveys may also be returned to standards@mhcirl.ie or by post to: Standards and Quality Assurance, Mental Health Commission, Waterloo Road, Dublin 4 D04 E5W7. 

For queries, or to request a physical copy of the survey, please contact standards@mhcirl.ie or telephone us on 01 636 2400.  

The consultation will close at 5pm on Tuesday 7 April 2026.

In addition to the consultation surveys, we will be holding focus groups and interviews with interested parties. If you would like to be involved in these, please email standards@mhcirl.ie by 5pm 7 April 2026
 

[i] Declining restrictive practice in approved centres in Ireland: improving quality of care through the adoption of a human rights-based approach | Irish Journal of Psychological Medicine | Cambridge Core