Restrictive Practices in Irish mental health centres down by almost 50% in five years

The combined numbers of restrictive practices in Irish mental health centres have decreased by almost 50% over the past five years, a new report by the Mental Health Commission (MHC) has confirmed.

Entitled ‘The Use of Restrictive Practices in Approved Centres’, the report documents the use of seclusion and restraint across 66 inpatient mental health centres across the country in 2023. It is the fifteenth such publication by the MHC and forms part of its remit to report independently on the quality and safety of mental health services in the State.

The report shows that total restrictive practices in approved centres decreased by 48.61% over the five years from 2019 (6,747 episodes) to 2023 (3,467 episodes). As part of this general decline, it demonstrates that there has been a marked reduction in these types of restraint over the past 12 months since the introduction of new rules by the MHC in January 2023.

When presented with the report, Minister for Mental Health and Older People, Mary Butler, said: “I welcome this positive report from the Mental Health Commission. It confirms that there has been a move away from restrictive practices, which is an important recommendation of our national mental health policy, Sharing the Vision. It is encouraging to see that there has been a downward trend over the last number of years in the use of restrictive practices, in line with the Mental Health Commission’s Reduction Strategy. I am particularly heartened that a human-rights approach is being embraced and adopted by staff in mental health services.

“It is important to highlight that sections of the new Mental Health Bill related to restrictive practices include a suite of safeguards for occasions when restrictive practices are required. In line with the spirit of the new Bill, this report reflects our more person-centred and human rights focused approach to mental health.”
The Chairperson of the Mental Health Commission, John Hillery, said: “The continuing fall in the use of restrictive practices shows the symbiotic effect of robust regulation and motivated mental health service staff in promoting the evolution of human rights-based inpatient services for vulnerable patients in Ireland.”

The Chief Executive of the Mental Health Commission, John Farrelly, said: “From 2008 to 2018, episodes of physical restraint and the number of residents that were being physically restrained increased year-on-year,” he said. “It is, therefore, encouraging to note that our work with service providers over the past five years has helped reduce episodes of physical restraint, and the number of residents that are physically restrained.

“It is clear from our work with them that this generation of clinicians are determined to ensure that everyone has a therapeutic encounter if or when they enter our mental health services, and that the use of coercion is not part of that culture.”

The Director of Regulation at the Mental Health Commission, Gary Kiernan, said: “The continuing decreases in restrictive practices are significant and indicate important, sustained human rights-informed progress in the way acute mental health services in Ireland are operated.”

The introduction of the revised Rules and Code - which came into effect on 1 January 2023 - occurred because of 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 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,” added Mr Kiernan.

“While there is a need for continued emphasis on seclusion and restraint reduction and elimination programmes in approved centres, we are hopeful that the revised Rules and Code will continue to reduce the use of restrictive practices and further protect the rights of persons receiving mental health care in this country.”

Minister Butler concluded: “I would like to take this opportunity to thank all those working in our mental health services. They have shown a long-standing commitment to promote, encourage and foster high standards and good practices, embracing a human right and lived experience informed approach, as they deliver mental health supports and services across the country.”

Please follow this link to the full report: The Use of Restrictive Practices in Approved Centres

Please follow this link to our full statement: ‘The Use of Restrictive Practices in Approved Centres’ 2023 Press Release