Authors: Neeraj Gill, Michael Tervit, Gino Richter, Stefan Preissler, Dr Sofie Hateley, Nicole Murphy & Matthew Coates
Event: 2023 The MHS conference - Adelaide
Subject: Opening the doors – Creating less restrictive alternatives to locked mental health wards in Queensland
Type of resource: Video
Abstract: Aims of the presentation: To inform participants of the human rights implications of locked mental health wards; other negative therapeutic impacts; the locked wards directive in Queensland; and experiences at two Queensland hospitals (Gold Coast and Cairns) with alternative models that include discretionary opening of the wards.
The presentation supports the overall conference theme of ' Making Rights Real - bringing humanity and human rights into mental health’ by advocating for better human rights protections for patients on locked mental health wards through less restrictive open-door models.
Background: In 2013, the Queensland Government issued a policy directive to lock all acute adult public mental health inpatient wards. This impacted on the staff, involuntary and voluntary patients within these units. Despite criticism from professional bodies and advocacy for an alternative, the policy has been retained to this day. A blanket directive to treat all psychiatric inpatients in a locked environment without individualised consideration of safety is inconsistent with least restrictive recovery-oriented care. It is against the principles of the United Nations Convention on the Rights of Persons with Disabilities and Optional Protocol of Convention Against Torture (OPCAT), to which Australia is a signatory.
Queensland Health has reported a reduction in ‘absences without permission’ from psychiatric inpatient wards after the introduction of the locked wards policy; however, no in-depth analysis of the consequences of this policy has been conducted. A review of the international literature found little evidence of reduced absconding from locked wards. Disadvantages for inpatients of locked wards include lowered self-esteem and autonomy, and a sense of exclusion, confinement and stigma, increased patient aggression, violence and self-harm. Locked wards are also associated with lower satisfaction with services, higher rates of medication refusal, and concern people may avoid seeking treatment as a result. On the contrary, there is significant international evidence that models of care like Safewards and having open door policies can improve the environment on inpatient units and may lead to less need for containment and restrictive practices.
In 2014, in response to the locked ward directive, the Queensland Mental Health Commission produced a paper ‘Options for Reform: Moving towards a more recovery-oriented, least restrictive approach in acute mental health wards including locked wards ’, that outlined options for reform that respond to local circumstances in Queensland’s acute mental health wards and offer better outcomes for patients, hospital staff and the community.
The report highlights that international, national and Queensland policies indicate wards should be recovery orientated and least restrictive and, on this basis, the wards would start from a position of being open. The report supports the case for flexible, localised decision-making by ward managers and clinicians around the needs of individual consumers in their care rather than a one-size-fits-all approach.
There has been no change to the locked wards directive, despite the Queensland Public Advocate calling for a review in his Submission: Inquiry into the opportunities to improve mental health outcomes for Queenslanders (February 2022). However, in a positive change of policy direction four Hospital and Health Services in Queensland have recently been granted an exemption and are trialling alternative models.
Method: Representatives from the Gold Coast and Cairns Hospital and Health Services will talk about their experience of discretionary opening the wards. They will highlight a different approach to risk aversion which seems to have been a major barrier for locked wards reform. Their experience can encourage others to implement alternative, less restrictive, evidence-informed, recovery-orientated models to protect the human rights of patients without neglecting patient, community and staff safety.
Conclusion: Locked mental health wards impact the human rights of patients and have negative therapeutic impacts. Alternative open-door models, such as discretionary opening of the doors have shown that they can appropriately manage risks of patient, staff, and community safety. They also have the potential to achieve better recovery outcomes.
1. Gill NS, Parker S, Amos A et al. Opening the doors: Critically examining the locked wards policy for public mental health inpatient units in Queensland Australia. Australian and New Zealand Journal of Psychiatry. 2021. 2021. Vol. 55(9) 844 – 848
2. Queensland Mental Health Commission (2014). Options for Reform: Moving towards a more recovery-oriented, least restrictive approach in acute mental health wards including locked wards. https://www.qmhc.qld.gov.au/sites/default/files/wp-content/uploads/2014/06/REPORT_QMHC-Options-for-Reform_PUBLISHED.pdf
To inform participants of the human rights implications of locked mental health wards; other negative therapeutic impacts; the locked wards directive in Queensland; and experiences at two Queensland hospitals (Gold Coast and Cairns) with alternative models that include discretionary opening of the wards.