Restrictive interventions in an adult psychiatric inpatient unit: A retrospective analysis following the implementation of the mental health and wellbeing act 2022

Background Restrictive interventions (RIs), including seclusion, physical and chemical restraint, remain controversial in psychiatric care. In Victoria, Australia, the Mental Health and Wellbeing Act 2022 (MHWA) strengthened expectations to reduce RIs. Objective To examine RI use in an adult acute psychiatric inpatient unit during the first year of the MHWA implementation. Method A retrospective cohort study was conducted using routinely collected data (1 September 2023–31 August 2024). Patients with at least one RI ( n = 66) were compared with patients without RI exposure ( n = 66). Group comparisons and logistic regression examined factors associated with RI exposure. Results Three hundred RI episodes were recorded, predominantly physical restraint (66.7%) and seclusion (32.3%). Medication was administered in 54% of RI episodes, most often intramuscularly. Threatened or actual violence was the most frequent precipitant. Primary psychiatric diagnosis was independently associated with RI exposure, with psychotic and bipolar disorders showing increased odds. RI-exposed patients had longer admissions (median 23.5 vs 9 days, p < .001). Conclusions RIs were primarily used in response to acute behavioural escalation associated with severe mental illness. These findings provide an early description of RI use following MHWA implementation and highlight the importance of consistent reporting and strategies to reduce RIs.