A ban on the use of mechanical restraint for children has been issued by the Mental Health Commission (MHC).
It follows a review and consultation process by the regulator on the rules and code of practice governing the use of restrictive practices in inpatient mental health settings in Ireland.
The outcome of the review, which commenced more than 18 months ago, sees the introduction by the MHC of new rules for seclusion and mechanical restraint, and a new code of practice for physical restraint, all of which will come into force in January.
In 2021, there were a total of 4,636 episodes of seclusion and physical restraint recorded nationally, which involved 1,790 residents of approved centres.
This represented a decrease from 2020, where there was a total of 5,830 episodes of seclusion and physical restraint, involving 1,880 residents.
In 2019, there were a total of 6,747 combined episodes of seclusion and physical restraint, involving 1,803 residents.
The use of mechanical restraint also decreased in 2021 in comparison to 2020, and its use as a restrictive practice in approved centres remains low.
The new rules include an outright ban on mechanical means of bodily restraint for children, including the use of hand and leg cuffs.
They will also require all public and private services to publish information about their efforts to reduce and, where possible, eliminate the use of restrictive practices.
The new rules and code were published this morning by the MHC in tandem with the 2021 Restrictive Practices Activities Report, which documents the use of these practices across 67 inpatient mental health centres in Ireland in 2021.
Although the report shows that there has been a substantial reduction in episodes of restraint and seclusion since 2020, the purpose of the new rules and code of practice is, according to the MHC, to bring about further improvements and ensure that these practices are only used in exceptional circumstances.
In addition to carrying out a review of the published national and international academic evidence, the MHC also met and spoke with people who have experienced restrictive practices, as well as staff and clinicians in mental health services.
The Director of Regulation for the Mental Health Commission has said that the use of these interventions may increase the risk of trauma and trigger symptoms associated with previous experiences of trauma.
"Therefore, they must only be used in rare and exceptional circumstances as an emergency measure to keep the person or those around them safe," according to Gary Kiernan.
"The published evidence shows that children and young people are particularly vulnerable to trauma and injury as a result of these practices. We have paid particular attention to this area, and introduced a number of new provisions to protect children, including a complete ban on mechanical means of bodily restraint for children," he said.
The MHC said it wanted to ensure that services intervene with restrictive practices "only when absolutely necessary" and prioritise positive engagement and empowerment of the person to regain self-control.
The Chief Executive of the Mental Health Commission, John Farrelly, said that although restrictive practices may, on occasion, be necessary to maintain safety in the day-to-day environment of an acute mental health service, the MHC still expects to see reductions in the use of these practices from 2023.
