Psychiatrists in Victoria have warned of uncertainty around the state’s “vague” new chemical restraint guidelines as mental health services prepare for new laws to take effect.
The new Mental Health and Wellbeing Act was a key recommendation of a landmark royal commission and was designed to protect human rights in mental health settings across the state.
The act, which will come into effect on Friday, will for the first time regulate the use of chemical restraint in mental health services.
Chemical restraints are medications given primarily to control behaviour, rather than to treat an illness or condition.
But two psychiatrists working in Victoria’s public mental health sector, who requested anonymity, said they feared the department’s “vague” guidelines about chemical restraint would spark anxiety among staff and could lead to greater workforce shortages.
“It’s not clear what the threshold for chemical restraint is. The vagueness is confusing so any two clinicians could debate about whether something is or is not chemical restraint,” one said.
“I think we could struggle to retain staff if people are being asked to work in an unclear legal environment.”
The state’s peak psychiatrist body says Victoria’s health system is not ready to fully comply with the new act because of workforce gaps and a tight timeframe for understanding and implementing guidelines.
Simon Stafrace, the Victorian chair of the Royal Australian and New Zealand College of Psychiatrists, said the department had only provided mental health services with updated guidelines last week about restrictive intervention practices, including chemical restraint as well as physical restraint and seclusion.
“The Victorian branch believes the sector is not ready to be fully compliant with the act by 1 September,” he said. “There’s more work to be done.”
Stafrace said there was uncertainty in the sector about how to implement technical elements of the legislation, particularly around the definition of chemical restraint compared with treatment.
He said shortages of mental health professionals also remained a barrier to implementing the royal commission’s recommendations.
“It’s much easier to provide care that is orientated towards people’s wishes … and to deliver on human rights considerations if you have time. And time comes with people,” he said.
He was confident the reform would improve treatment once fully implemented, but he said the sector had to ensure the transition did not have a negative impact on those who use the system.
“Many of us are concerned about the possibility that people will be demoralised, disappointed and distrustful if we don’t get this right quickly,” he said.
The Andrews government has committed to stamping out seclusion and restraint in mental health facilities by 2031. This was a key recommendation of the state’s mental health royal commission, which concluded some consumers had their human rights breached through compulsory treatment, seclusion and restraint.
The government’s interim aim is to reduce restrictive practices by 20% by April.
Prof Patrick McGorry, a psychiatrist and the executive director of youth mental health body Orygen, said it was unlikely the interim April deadline would be met. “We’d have to speed up the implementation of the royal commission for that to be achieved,” he said.
Craig Wallace, the chief executive of the Victorian Mental Illness Awareness Council, said the body wanted seclusion and restraint to end as quickly as possible.
“We think a 10-year timeline is too long,” he said.
A 2022 report by the Victorian Mental Illness Awareness Council revealed the system was still secluding and restraining people more frequently and for longer than national averages.
A Victorian government spokesperson said it was working hard to ensure the sector was ready and the workforce would be supported to deliver reform under the new legislation.
“The new Mental Health and Wellbeing Act lays the foundation for delivering a transformed mental health system, embedding human rights and lived experience in every part of the new system,” the spokesperson said.
