ABSTRACT
Multiple forces drive the need to reduce coercive and restrictive interventions such as seclusion and restraint in Victoria and other jurisdictions in Australia and internationally. The recovery movement, the United Nations Convention on the Rights of Persons with Disabilities, the contribution of people with lived experience, the concerns of clinicians and research evidence are all potential drivers of system transformation. This transformation is occurring at the intersections of practice, ethics, rights, policy and law, but active reform is proving to be inconsistent and in danger of losing momentum. Several challenges, barriers and concerns have been identified in reducing seclusion and restraint and advancing recovery-oriented practice. Most challenges are related to the culture and practice on wards and within organisations, with risk, fear, stigma and discrimination being overarching themes. It appears that system change requires improved and consistent recognition of the human rights issues, trauma and harm associated with coercive interventions. Facing up to the very real issue of stigma and discrimination among staff, as well as staff’s experience of fear in the face of potential risks, requires supportive management and leadership. Lived experience roles, or peer support, offer great potential for achieving long-lasting transformation.
