Narrative Review and Meta-Ethnography of Seclusion and Restraint From the Perspectives of Adults With Lived Experience: A Human Rights Issue and Application to Australian Context

Abstract

Research literature does not sufficiently address the causes of human rights abuse involved in the use of seclusion and restraint for people experiencing mental health concerns. This article uses a socio-political analysis alongside in-depth exploration of lived experience accounts, to emphasise that the use of restrictive practices is an abuse of human rights. A narrative literature review consistent with the PRISMA 2020 statement identified three major themes: (1) first-person accounts of violent, degrading and dehumanising practices in mental health facilities; (2) inpatient care as a risk factor to mental health/wellbeing (compounded distress, retraumatisation, vicious cycles of restrictive practices); and (3) the need for trauma-informed care and systems-level change. Systemic change and elimination of seclusion and restraint in psychiatric settings are possible through the adoption of alternative practices, widespread education on no-restraint methods and integration of human rights values in care. However, there is a continuing lack of political will to adequately resource mental health services in Australia to enable systemic change. This results in the current system being maintained and upheld, and the continued use of seclusion and restraint. With a lack of access to trauma-informed approaches and a lack of organisational support, mental health practitioners continue to use restrictive practices, resulting in iatrogenic harm.