​​This fact sheet outlines the actions being undertaken by NSW Health to improve the built and therapeutic environments in mental health care following the Review of seclusion, restraint and observation of consumers with a mental illness in NSW Health facilities.

Last updated: 19 March 2019

What’s happening?

Following the ‘Review of seclusion, restraint and observation of consumers with a mental illness in NSW Health facilities’, we will implement the following recommendations.

The NSW Government has committed $20 million to improve the physical environment and overall in-patient experience. The funding will help provide infrastructure, resources and equipment. The peak mental health consumer and carer organisations (Being and Mental Health Carers NSW), Mental Health Commission of NSW and the Official Visitors Program are partners in this work.

Recommendation Action
15. All emergency departments should have clinical pathways for people presenting with mental health issues that are reflective of their needs. There needs to be a pathway that does not include the use of safe assessment rooms Ensure clinical pathways in emergency departments reflect the needs of people with mental illness, including alternatives of safe assessment rooms
16. There should be an immediate review of the design and use of safe assessment rooms using a co-design methodology Review how safe assessment rooms in emergency departments and involve consumers in their design
17. All future capital planning of mental health facilities should include consumer co-design and be informed by evidence on preventing seclusion and restraint Ensure all capital planning of mental health facilities is evidence-based and clearly shows consumer involvement
18. All acute mental heal​th units and declared emergency departments should conduct a review ​of their facilities and implement minor capital works and equipment purchases to improve the therapeutic potential Implement of minor capital works and provide equipment to improve the therapeutic environment in consultation with consumers
19. All mental health units should have a multidisciplinary team with the skills to deliver a therapeutic program and environment on an extended hours basis Deliver therapeutic programs with more flexible hours

How can I be involved?

Every local health district and specialty health network will invite patients, carers and their families to be included in designing their prevention action plans. To find out more, contact your local health district.

What are built and therapeutic environments?

The inpatient environment can support or hinder recovery from mental health problems. Positive interactions between staff and consumers are the foundations of a therapeutic environment. The built environment can complement this therapeutic environment.

The built environment

Consumers have described the positive aspects of how a well-maintained, well-designed inpatient unit with a comforting feel can support personal recovery. Improvements to the physical environment have been associated with significant reductions in the use of seclusion and restraint. Changes can improve both the built environment and therapeutic interactions between staff and consumers.


It is not uncommon for people to feel a range of emotions when being admitted to hospital. They might be distressed, uncertain, anxious, relieved or angry. How services greet, reassure, comfort and orient people on admission can make a positive difference to the start of treatment. Some units have developed a ‘welcome pack’ using the experience of consumers, carers and families to support new consumers.

Peer workers

Peer workers are people with a personal experience of mental illness and recovery. They also have skills and qualifications to support the recovery of other mental health consumers. Their contribution includes giving hope to consumers.

Minimising restrictions

The Mental Health Act requires that mental health treatment should use the least restrictive alternatives. Consumers, carers and families can help services to review their ward routines. Reviewing visiting hours, mobile phone and other restrictions can support more positive relationships between staff and consumers, families and carers.

Personalised care

Providing consumers with choices supports recovery. Consumers may know their early warning signs of distress and what helps soothe them. They can help staff to detect these and intervene early. Consumers have identified that helpful care includes staff offering space to be alone, opportunities to talk or physical activity.

Evidence-based programs

The evidence for mental health treatments continues to grow. These include individual and group based therapies, some of which are targeted for specific disorders and others that are helpful for people with a range of illnesses. Sensory interventions are an example of one of the treatments with wider use. They can help people manage their emotions and often result in a decrease in the use of seclusion and physical restraint.

Current as at: Tuesday 19 March 2019
Contact page owner: Mental Health