WA’s chief psychiatrist Nathan Gibson condemns practice of restraining mentally ill patients face-down

WA’s chief psychiatrist has warned of an “extremely disturbing” increase in mentally ill people being harshly restrained “face down” over the past year — including kids. Nathan Gibson, who has to be notified by law when mental health patients are physically restrained, branded the rise in “poorly monitored” prone restraints as “unacceptable”. A total of 358 adults were restrained on 822 occasions in WA mental health wards or units in 2019-20, while there were 61 children and young people aged under 18 restrained on 173 occasions. However, Dr Gibson’s latest annual report did not specify how many of those were prone restraints. “An extremely disturbing trend began to emerge during 2019-20 in WA mental health units across several health service providers — the increased use of prone restraint, with inconsistent monitoring of physiological parameters during prone restraint. Prone restraint increases the risk of death during restraint,” he wrote. “WA continues to perform well working towards eliminating restrictive practice but the increase in poorly monitored prone restraint is unacceptable.” Dr Gibson said he had written to all WA public health service chief executives, asking for more local oversight of the problem and for prone restraint not to be used on patients. In 2011, then coroner Alastair Hope criticised Graylands Hospital staff for their readiness to restrain a distressed patient face down, who then died. Warwick Andrew Ashdown was 27 in October 2007 when he had a psychotic episode, which led him to being restrained face down on the ground by five men. He was held for several minutes before staff realised he had vomited and released him, but he died. Mr Hope recommended that the WA health department review restraint procedures and staff training. Dr Gibson said in his report that WA had lower rates of restraint and seclusion for children and adults than the national average. There were 5.8 restraints per 1000 bed days in WA in 2019-20, compared with 7.3 over average nationally in 2018- 19. But his report showed that the rate of restraints and seclusions of mental health patients had changed little over the past three years. “Taking an alternative view into new design concepts for mental health facilities has been challenging, as the traditional custodial view remains within the broader health environment,” Dr Gibson wrote. More than 10,500 people were held involuntarily for mental health treatment in WA in 2019. There were 2067 reports of aggression or assault involving adults, and more than 290 reported incidents involving aggression among children under 18. Of the 822 times adult patients who were physically restrained in WA in 2019-20, two thirds of them lasted less than five minutes, but 11 per cent lasted more than 10 minutes. Sixty-one patients under the age of 18 were restrained 173 times in 2019-20. Two thirds of them were girls and in 23 per cent of cases, the restraining lasted more than 10 minutes.