This document incorporates extensive experiential expertise through multiple channels: it was guided by an Expert Reference Group including consumer representatives, carer representatives, and clinical practitioners; benefited from contributions of mental health nurses via online surveys; adapted materials from Te Pou New Zealand's practical experience; and emphasized consumer, carer, and Aboriginal and Torres Strait Islander voices throughout development. The framework prioritizes lived experience perspectives in all strategies and implementation processes.
Safe in Care, Safe at Work Report
Overview
The Australian College of Mental Health Nurses developed "Safe in Care, Safe at Work" framework to reduce seclusion and restraint in mental health services. It adapts the Six Core Strategies focusing on staff safety, leadership, data use, workforce education, collaboration, and post-incident care to create safer therapeutic environments.
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Key insights
Key Insights:
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Staff fear influences seclusion/restraint use - addressing nurse safety reduces restrictive practices
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Six Core Strategies provide evidence-based framework for eliminating harmful seclusion and restraint
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Seclusion and restraint traumatise consumers, staff, and organisations and are considered care failures
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Mental health nurses experience highest assault rates - approaching 100% lifetime risk
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Leadership commitment and non-punitive culture essential for successful reduction of restrictive practices
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Data collection and monitoring crucial for measuring progress and identifying improvement areas
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Aboriginal and Torres Strait Islander perspectives must be included in all initiatives
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Post-incident debriefing and learning prevents future events while supporting affected parties
Did this resource draw on transformative evidence?
This document draws on substantial practice wisdom from frontline mental health nursing experience, including insights from nurses who participated in surveys about barriers and enablers to reducing seclusion and restraint. It incorporates clinical expertise from psychiatrists, chief mental health nurses, and hospital operations managers on the Expert Reference Group. The framework adapts proven strategies from international practice and reflects accumulated knowledge from mental health services across Australia about what works in real clinical settings.
This document is grounded in comprehensive research evidence, including systematic literature reviews of seclusion and restraint practices, evaluation studies of the Six Core Strategies' effectiveness internationally, and analysis of Australian mental health service data. It incorporates findings from focus groups and surveys examining nurse perceptions, builds on previous ACMHN research projects, and references extensive peer-reviewed literature. The framework integrates empirical evidence showing Six Core Strategies reduce incidents while improving staff satisfaction and consumer outcomes.