Experts are calling on Queensland to drop its locked door policy on mental health units, saying there is overwhelming evidence it is harming patients.
Key points:
- Locked door policy applies to voluntary and involuntary patients
- Experts say it goes against human rights standards
- Proponents say it should be replaced with a discretionary policy for separate units
Queensland is the only state in Australia to maintain the policy, which requires all entrance and exit doors to acute psychiatric care units in public hospitals to be locked.
This applies to all patients, whether they are there voluntarily or not.
Supporters say the policy, introduced in 2013, goes against Queensland’s Human Rights Act and Mental Health Act, as well as the UN Convention on the Rights of Persons disabilities.
Neeraj Gill co-authored a 2021 paper from Griffith University on the policy, along with senior psychiatrists and academics from Queensland universities, and argues that the policy does not promote patient recovery.
“If you have a physical illness you are admitted to an open ward, but if you have any mental illness you are admitted to a closed ward,” Dr Gill said.
The Mental Health Act (2016) of Queensland requires that any treatment be carried out in the least restrictive way and promote the recovery of the patient.
Dr Gill said the policy contradicts that intent, and he recommended a comprehensive review of the general policy and that mental health services should exercise discretion about when to lock down services.
Last year, the Queensland government did not allow full access to the UN Subcommittee on Prevention of Torture to inspect their “closed environments” – which included their locked quarters.
“My human rights have been violated”
Rebecca – whose name has been changed to protect her identity – has stayed in inpatient units in Queensland twice since 2017.
She was working in healthcare at the time and both times she was doing involuntary acts.
“I felt like my human rights had been violated,” she said.
“I went to leave at one point and was held up by six members of staff.
“I pressed the emergency call button on my Apple watch, and it called triple-0, and it would have recorded me screaming, screaming, being scared and held back.”
Rebecca said she didn’t know if that appeal had ever been considered.
Patients are afraid to ask to leave
In accordance with the security policy for acute psychiatric care units for adults, it is mandatory that patients and voluntary visitors can enter and leave the units freely.
Queensland Public Advocate John Chesterman said this did not translate easily into real practice.
“Sometimes people don’t realize they are free to come in and out,” Dr Chesterman said.
“You must obtain permission from staff members to be able to leave if you are a voluntary patient, and this may lead to assessments as to whether it is appropriate for you to leave.”
Matilda Alexander, CEO of Queensland Advocacy for Inclusion, said there were many cases where patients had asked to leave, but their situation had instead escalated into an involuntary order.
Rebecca said it was a common occurrence in theaters.
“It’s not obvious that you can leave if you want to,” she said.
She also said it was difficult to provide feedback to staff.
“You can put written complaints in the service’s complaints box, but nothing is done about that,” she said.
Calls for change
Dr. Chesterman, Mrs. Alexander and Rebecca want the gated community policy abolished.
“It should be replaced with a discretionary ward lockdown policy so that individual units can determine, in accordance with the human rights framework, whether the unit in question is locked down,” Dr Chesterman said.
They say it interferes with the right not to be arbitrarily deprived of liberty, which falls under state human rights law.
By law, the Queensland Government has an obligation not to detain people, particularly where it is not permitted by law.
“This is a clear and continuing violation of human rights, the right to liberty and security of person,” Ms Alexander said.
“It is not enough to restrain someone who is hospitalized voluntarily behind the closed door.”
Experts also say it goes against the Convention on the Rights of Persons with Disabilities.
Why was the policy introduced?
The policy was introduced in December 2013 under the TNL government of Campbell Newman.
The directive was issued out of concern for the number of people “absent without leave”.
This could mean that an involuntary patient left an acute mental health service without approval or was on community discharge but did not return to the service when needed.
But, according to Dr. Gill, the international literature shows that a general policy, without individualized consideration of risk, does not reduce leakage.
“There was no benefit to closing theaters in terms of suicide, suicide attempts or flight,” he said.
Its report notes that the indiscriminate confinement of patients leads to a decrease in self-esteem and autonomy, a feeling of exclusion, confinement and stigmatization.
It also translates into lower satisfaction with services and higher rates of drug refusal.
Rebecca said that in the closed wards, patients were often in distress.
A spokesperson for Queensland Health said the policy had been “essential” to “protect patient and community safety” and had reduced rates of patients absent without approval.
Alternative solutions
There are calls to implement a safe neighborhoods program as an alternative to the locked neighborhoods policy.
The program, which originated in the UK, was designed to reduce conflict and confinement in psychiatric wards.
This involves a range of interventions, including better communication between staff and patients, providing de-escalation strategies, using positive language, distraction and sensory modulation to manage anger.
The Safe wards scheme was piloted on the Gold Coast in 2021.
A Queensland Health spokesperson said the trial used discretionary lockdown in an eight-bed short-stay inpatient unit.
“The results of the trial assessment to date have been positive with no increase in absences without approval,” the spokesperson said.
Dr Chesterman said he supported Queensland’s move towards a safety agenda.
The same goes for the Queensland Mental Health Commission.
“The commission supports a safe neighborhoods approach that includes the reduction of restrictive practices and local decision-making on whether neighborhoods need to be locked down,” a spokesperson said.
Rebecca said she wanted patients to have more autonomy over their own treatment on the Queensland inpatient unit.
“I think we should have influence (on human rights law) in Queensland specifically, but in Australia as a whole, so that we can have fully informed consent,” she said. .
