Benchmarking to reduce restrictive practices in forensic mental health services: a Delphi study

Area of Science:

• Forensic mental health
• Clinical practice improvement
• Patient safety

Background:

• Forensic mental health services (FMHS) report high rates of restrictive practices, including seclusion, physical restraint, and mechanical restraint.
• Restrictive practices significantly impact patient well-being and service resource allocation.
• The need for standardized measures to reduce these practices is critical.

Purpose of the Study:

• To develop evidence-based benchmarks for restrictive practices within Australian and New Zealand FMHS.
• To establish targets for reducing the rate, duration, and frequency of seclusion and restraint.
• To facilitate comparative analysis and quality improvement initiatives across FMHS.

Main Methods:

• A Delphi study employing participatory action research methodology.
• Collection of de-identified, service-specific restrictive practice data from FMHS experts.
• Facilitation of expert consensus on benchmark development through data-driven reflection.

Main Results:

• Consensus was achieved on benchmarks for the rate, duration, and frequency of seclusion and physical restraint.
• Mechanical restraint was identified as a rare occurrence, necessitating individualized service reviews.
• The developed benchmarks provide a basis for inter-service comparison and performance evaluation.

Conclusions:

• Benchmarking in FMHS can drive reductions in restrictive practices and enhance service scrutiny.
• Establishing a network of FMHS is recommended to support the implementation and embedding of proposed benchmarks.
• Continuous monitoring and data sharing are essential for sustained improvement in patient care and safety.