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Options for Reform: Moving towards a more recovery-oriented, least restrictive approach in acute mental health wards, including locked wards, December 2014

A  cornerstone  of  recovery-­‐oriented  practice  is  the  recognition  that  people  requiring  care  and  treatment  for their  mental  illness  are  provided  with  care  in  as  least  restrictive  manner  as  possible.

Recovery-­‐oriented  mental   health  service  delivery  is  defined  by  A  National  Framework  for  recovery-­‐oriented  mental  health  services:  Guide   for  practitioners  and  providers as  the  ‘application  of  sets  of  capabilities  that  support  people  to recognise  and   take  responsibility  for  their  own  recovery  and  wellbeing  and  to  define  their  goals,  wishes  and  aspirations.’  

Least  restrictive  practices  form  an  essential  foundation  to  a  recovery-­‐oriented  approach.  Implementing  least   restrictive  practices  has  been  accepted  internationally  and  nationally  as  best  practice.  The  World  Health   Organisation’s  Mental Health Care  Law:  Ten  Basic  Principles include  the  provision  of  least  restrictive  practices   and  indicate  that  institution-­‐based  treatments  should  be  provided  in  the  least  restrictive  environment.

Queensland,  like  all  other  Australian  States  and  Territories, enshrined  commitments  to  implementing  least   restrictive  practices  in  their  legislation and  has  been  working  towards a  recovery-­‐oriented  approach, and   implementing  least  restrictive practices  in  its  mental  health  wards. 

Few  policies  adopt  a  ‘whole-­‐of-­‐ward’  approach  to  least  restrictive  practices  or  recovery-­‐oriented  services.  Of   particular  note  is  the  lack  of  practical  recommendations  in  the  literature  for  least  restrictive  care  in  acute   mental  health  units.  

This  report outlines  options  for  reform  to  support  recovery-­‐oriented  practice  and  the  implementation  of  least   restrictive  practices  in  acute  mental  health  wards,  with  a  particular  focus  on  the  role  of  locked  wards. It  sets   out  evidence-­‐informed reforms  which  aim  to strengthen  recovery-­‐oriented  approaches  and  least  restrictive   practices  under  three  areas:  

  • supportive  relationships

  • organisational  culture

  • monitoring  and  review  of  recovery-­‐oriented  practice.

The  report  sets out 15 options  for  reform  to  enhance  recovery-­‐ oriented,  least  restrictive  approaches  in  acute  mental  health  wards in  Queensland.