Background: There is a growing consensus to reduce the use of restrictive care practices in mental health settings to minimise the physical and psychological complications for patients. However, data regarding restrictive care practice use and factors contributing to variations in the proportion estimates has not previously been synthesised.Aims: This study aimed to synthesise evidence on (1) the pooled proportions of physical restraint, seclusion or chemical restraint in adult mental health inpatients and (2) sources of variability in these proportion estimates.Methods: Studies were identified from Scopus, MEDLINE, PsycINFO, Web of Science, Embase and CINAHL databases following the PRISMA 2020 guidelines. We conducted a meta‐analysis of studies published in English language from 1 January 2010 to 15 August 2022. Binomial data were pooled using a random effect model, with 95% confidence intervals. Meta‐regression was also computed to identify factors that may contribute to variations in the proportion estimates.Results: A total of 77 studies were included in this meta‐analysis. The pooled prevalence of physical restraint, seclusion and chemical restraint was 14.4%, 15.8% and 25.7%, respectively. Data were heterogeneous across studies (I² > 99%). Reporting practices and geographical locations contributed to the variability in the reported estimates of restrictive care practices, with studies from Asian countries reporting higher proportions.Conclusion: There appear differences between geographical locations in the proportion of restrictive practices in mental health inpatients; however, this is complicated by how these prevalence data have been measured and defined. Consistency in the reporting of restrictive care practices in mental health is required to make valid comparisons between geographical regions, policy settings and practice innovations.Relevance to Clinical Practice: Efforts are needed to develop training programmes and policy changes to ensure consistency in defining and reporting of restrictive care practices in mental health facilities.Patient/Public Contribution: This is a systematic review that analysed data from previously published studies, and there was no patient/public contribution in this study.Protocol Registration: The protocol for this review has been registered to PROSPERO: CRD42022335167.

Service users and their families have raised concerns about safety in current acute mental health service delivery. Restrictive interventions are routinely used across mental health settings despite increasing awareness of the negative impacts. Underfunding and risk-averse management practices are implicated as key challenges. Utilizing a scoping review and thematic analysis method, this review explored the existing literature of mental health staff perspectives across various settings (including psychiatric wards and emergency departments), focusing on their experience of restrictive interventions. Four themes were developed: 1. Safety (both staff and patient); 2. Barriers to staff reducing their restrictive interventions; 3. Strength in current practice; 4. Recommendations for change. Key gaps in the literature were the limited perspectives of emergency and crisis clinicians (despite these areas being settings where restrictive interventions are utilized) and limited perspectives from allied health disciplines (despite their employment as clinicians in these settings). It also noted a divide between staff and patient safety, as though these concerns are mutually exclusive rather than cooccurring, which is the experienced reality. Advocacy bodies, governments and the media are calling for a reduction in restrictive interventions in crisis settings. This research synthesis proposes that, to achieve this, clinical staff must be involved in the process and their perspectives actively sought and drawn upon to enable reform.

Young people transitioning from out-of-home care (often called care leavers) are globally a disadvantaged group who can be particularly vulnerable to experiences of housing instability and homelessness. This article presents a scoping review of international scholarly literature pertaining to housing pathways for care leavers from 2015–2020. The 15 publications identified were analysed according to location, methodology, sample accessed, key findings regarding housing pathways and outcomes, and recommendations for policy and practice reform. Our findings suggest that good transition planning, continuing support from responsible adults, the availability of safe and affordable housing and extended care till at least 21 years should enable more positive housing transitions.

The authors bring decades of work in mental health direct practice to inform this chapter. The chapter explores theory underpinning practice, by providing an overview of frameworks for practice, and also explores mental health legislation in Australia and internationally. It also provides an overview of how to assess and intervene when working with people with mental health issues. It provides an overview of diagnoses experienced by people, exploring both low-and high-prevalence disorders. Throughout the chapter there are examples provided of models commonly used within the mental health field. Across all these domains the authors highlight some of the ethical issues that arise in mental health social work. Raising these ethical issues will encourage the reader to consider critical approaches to social work and their application.

This chapter offers insights, reflections and case studies from mental health clinicians working in public mental health services which use restrictive settings - crisis mental health settings both in the community (Crisis Assessment and Treatment Teams - CATT) and the emergency department (Emergency Psychiatric Service or Emergency Department Mental Health Teams). Contributors to this chapter have extensive mental health experience in crisis teams. Social work practice in statutory mental health settings has long been debated. Critics argue that involvement in systems that enforce restrictive practices, such as seclusion, restraint, and involuntary treatment, contradicts social work's commitment to human rights. Conversely, contemporary perspectives advocate for social workers' participation in these settings to safeguard rights and influence systemic reform from within. This tension underscores the complexity of social work roles in crisis mental health services, where restrictive practices remain prevalent despite global calls for their elimination.