Consumers' and their supporters' perspectives on barriers and strategies to reducing seclusion and restraint in mental health settings.

Objective This paper examines the perspectives of consumers and their supporters regarding the use of seclusion and restraint in mental health settings. Methods Five focus groups for consumers and five focus groups for supporters were conducted in four Australian cities and in one rural location. The 66 participants were asked about strategies to reduce or eliminate the use of seclusion and restraint in mental health settings. Results All participants supported the reduction of the use of seclusion and restraint. Barriers to reducing these practices related to the environment, the effects of drug and alcohol issues, lack of a human rights focus and poor recognition of trauma, stigma and discrimination. Strategies for reducing or eliminating seclusion and restraint included workforce development, environmental and cultural changes. Conclusions Participants clearly identified that the status quo needs to change and conveyed urgency for action. Participants suggested that the involvement of supporters and a range of consumer roles are integral to reducing the use of seclusion and restraint. The findings support the current policy emphasis of working towards the elimination of these practices. What is known about the topic? Mental health policies across many jurisdictions support the reduction and elimination of restraint and seclusion. Evidence suggests those subjected to restraint and seclusion largely experience a range of harmful consequences. No studies focus on the views of supporters of consumers regarding the reduction and elimination of seclusion and restraint, whereas the views of consumers appear in a minority of international studies. What does this paper add? The research enabled an opportunity to hear from people who have been personally affected by and/or have lived experience of these coercive practices. Participants identified local reforms that can uphold the human rights of consumers. They suggested practices to increase accountability, peer support and family involvement, areas that have not been analysed in depth in any of the seclusion and restraint literature. What are the implications for practitioners? This paper will give healthcare services a deeper insight into how to reduce or eliminate restraint or seclusion from the perspective of those with lived experience.

Factors Affecting Mental Health Professionals' Sharing of Their Lived Experience in the Workplace: A Scoping Review.

OBJECTIVE: Research has suggested that some mental health professionals (MHPs) continue to hold stigmatized beliefs about persons with emotional distress. These beliefs may be amenable to contact-based interventions with similar peers. To inform future interventions, policy, and research, this scoping review examined existing literature to identify factors that affect disclosure of lived experience by MHPs to colleagues and supervisors. METHODS: A systematic search was conducted of four online databases, gray literature, and the reference lists of included articles. Primary research studies of any design conducted with MHPs with lived experience of emotional distress and their colleagues were included. The findings of included studies were inductively coded within the themes of enabling, constraining, and intrapersonal factors influencing disclosure. RESULTS: A total of 23 studies were included in data extraction and synthesis. Factors that influenced MHPs' sharing of their lived experience in the workplace were categorized into five overarching themes: the "impaired professional," the "us and them" divide, the "wounded healer," belief in the continuum of emotional distress, and negotiating hybrid identities. MHPs with lived experience described feeling conflict between professional and service user identities that affected the integration and use of their clinical and experiential knowledge. Enabling factors reflected best-practice human resource management, such as organizational leadership, access to supervision and training, inclusive recruitment practices, and the provision of reasonable accommodations. CONCLUSIONS: Findings of this scoping review suggest that organizational interventions to support MHPs in order to share their lived experience may improve workplace diversity and well-being, with implications for service users' experience.

A cluster analysis of people on Community Treatment Orders in Victoria, Australia.

This paper explores the clinical, social and demographic characteristics of 164 people on Community Treatment Orders (CTOs) in one area mental health service in Victoria, Australia. The results of an exploratory cluster analysis are presented to address the question of whether people on Community Treatment Orders can be categorised into statistically reliable, qualitatively distinct groupings. The data are presented in the context of key stakeholder perspectives on the current use and purpose of CTOs. Three stable clusters emerged and each potentially reflects how social dimensions, as well as clinical issues, influence decision making regarding the implementation of CTOs. These findings are important in the context of policy and practice in Victoria, where the use of CTOs is common practice, and orders are generally made for a 12 month period. The potential for improved targeting of CTOs and more specific treatment planning is identified.

Consumers and Carer perspectives on poor practice and the use of seclusion and restraint in mental health settings: results from Australian focus groups.

BACKGROUND: Seclusion and restraint are interventions currently permitted for use in mental health services to control or manage a person's behaviour. In Australia, serious concerns about the use of such seclusion and restraint have been raised at least since 1993. Consumers and their supporters have also expressed strong views about the harm of these practices. This paper presents the results of ten focus group discussions with people with lived experience of mental health issues and also carers, family members and support persons in relation to the use of seclusion and restraint. METHODS: The 30 consumers and 36 supporters participating in the focus groups convened in four Australian cities and one regional centre discussed their understandings of the use of seclusion and restraint and its impact on the people involved. Participants also presented their observations about poor practice and what contributes to it as well as providing ideas and recommendations regarding strategies to reduce or eliminate seclusion and restraint. Focus group discussions were recorded and transcribed, then analysed using the NVivo 10 qualitative data analysis software with a general inductive approach used to analyse data. This analysis enabled consideration of the responses to key questions in the focus groups as well as the identification of emerging themes. RESULTS: Six themes emerged from the analysis, these being: human rights, trauma, control, isolation, dehumanisation and 'othering', and anti-recovery. Examples of poor practice identified by focus groups included the use of excessive force, lack of empathy/paternalistic attitudes, lack of communication and interaction and a lack of alternative strategies to the use of seclusion and restraint. There was a confluence of factors identified by participants as contributing to poor practice, with the main factors being organisational culture, the physical environment, under-resourced mental health services and fear and stigma. CONCLUSIONS: Focus group participants in the main viewed seclusion and restraint practices in mental health settings as unnecessarily overused, exacerbating problems for individuals, carers, staff and the broader system of care. This study highlights that lived experience of both consumers and their supporters can make an important contribution to mental health services and its ongoing reform.

Erratum to: Consumers and their supporters' perspectives on poor practice and the use of seclusion and restraint in mental health settings: results from Australian focus groups.

[This corrects the article DOI: 10.1186/s13033-016-0038-x.].