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Canberra Hospital and Health ServicesOperational ProcedureDhulwa Mental Health Unit (DMHU) - Use of Force by Authorised Health Practitioners, Security Officers, Court Security Officers and Escort Officers Contents

Purpose.....................................................................................................................................3

Scope........................................................................................................................................ 3

Alerts.........................................................................................................................................3

Scope........................................................................................................................................ 3

Section 1 – Security Principles..................................................................................................4

Section 2 – Application of Force................................................................................................4

2.1 Risk Assessment......................................................................................................... 4

2.2 De-escalation..............................................................................................................5

2.3 Physical Restraint....................................................................................................... 5

2.4 Forcible Giving of Medication.....................................................................................5

2.5 Seclusion.....................................................................................................................6

2.6 Use of Handcuffs inside DMHU...................................................................................7

2.6.1 Who can authorise the use of handcuffs in the DMHU........................................7

Section 3 – Care of a Consumer Post Use of Force...................................................................7

Section 4 – Care of Staff Post Use of Force...............................................................................7

Section 5 – Documentation Requirements for Use of Force.....................................................8

6.1 Use of Force Registers................................................................................................8

6.1.1 Clinical Registers..................................................................................................8

6.1.2 Security Registers................................................................................................9

6.2 Reporting Incidents of the Use of Force.....................................................................9

6.2.1 Public Advocate and Official Visitors...................................................................9

6.2.2 Riskman....................................................................................................................9

6.5 Review of Use of forces episodes.............................................................................10

6.6 Closed Circuit Television (CCTV) Footage or Other Camera Footage........................10

Implementation...................................................................................................................... 10

Related Policies, Procedures, Guidelines and Legislation.......................................................10

Doc Number Version Issued Review Date Area Responsible PageCHHS16/200 1 25/10/2016 01/09/2021 MHJHADS 1 of 17

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Definition of Terms................................................................................................................. 11

Search Terms.......................................................................................................................... 12

Attachment 1 – Use of Handcuffs...........................................................................................12

Attachment 1 – Use of Handcuffs........................................................................................13


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Purpose

The purpose of this procedure is to ensure that the use of force is exercised proportionately in accordance with ACT legislation and common law duty of care principles.

The use of force is only used: As a measure of last resort To protect the safety and security or good order of the DMHU When the force used is in line with legislative requirements, and When any consequent breach of human rights is reasonable and proportionate to the

risks being addressed, and is for the minimum force and time necessary.

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Scope

Alerts

This Procedure should be read in conjunction with the Mental Health (Secure Facilities) Act 2016, the Mental Health Act 2015, the Security Industry Act 2003, Crimes Act 1900 and the Court Procedures Act 2004.


Scope

This procedure pertains to all Authorised Health Practitioners, Security Officers, Court Security Officers and Escort Officers who are engaged to carry out duties at the DMHU or whilst conducting escort duties to and/or from the DMHU in accordance with the Mental Health (Secure Facilities) Act 2016, the Mental Health Act 2015, and the Security Industry Act 2003, and the Court Procedures Act 2004 (if applicable to Security Officers and Court Security Officers).

Section 69 of the Mental Health (Secure Facilities) Act 2016 authorises the Director-General to appoint Authorised Officers. For the purpose of this Procedure Authorised Officers refers to Security Officers.

Court Security Officers are Security Officers, appointed under the Court Procedures Act 2004, performing security duties in relation to an ACAT Hearing at the DMHU.



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Section 1 – Security Principles

The DMHU Security Procedural Framework (SPF) has been developed to provide a framework for the security procedures and personnel in the DMHU. The three principles of security central to the framework are: Physical security systems, such as Closed Circuit Television (CCTV), swipe cards,

biometric identification, electronic door alarms etc Procedural security, which refers to integrated security procedures, which

complement clinical requirements, and Relational security, which refers to the positive, constructive and therapeutic

relationships between all staff in the DMHU, clinical and security, and the consumers who are admitted to the DMHU.

These objectives and principles imply and necessitate a close collaborative relationship between Authorised Health Practitioners, Security Officers, Court Security Officers and Escort Officers, whilst providing a boundary to the limits of information sharing and an appreciation for professional differences. Ongoing communication between all of these staff is essential to ensure awareness and agreement of different roles and responsibilities

There will be daily communication between the Security Supervisor, the Facility Manager, and the Nurse in Charge (NIC). Each will be aware of the daily operational activities, and of the necessary arrangements to ensure security requirements. This includes the location and movements of all consumers, staff, contractors and visitors.


Section 2 – Application of Force

The safety of everyone involved safety is the primary concern when dealing with an incident that may necessitate force being used. Under the Mental Health (Secure Facilities) Act 2016, Authorised Health Practitioners, Security Officers, Court Security Officers or Escort Officers (see definition of terms) are authorised to use force. All staff engaging in the application of force must have completed Violence Prevention Management (VPM) Training.

When the use of force is necessary, all efforts should be made to minimise the potential of injury of everyone involved including the consumer(s) and staff member(s).

When Use of force is required the following the following intervention model should be adopted.

2.1 Risk Assessment Whenever the situation permits (i.e. except in emergency situations), the potential level of risk should be assessed, using the following sources of information: Treatment, Placement, Restrictions, Implementation and Monitoring Plan (TPRIM);


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Clinical Risk Assessment and Management (CRAM) HCR20 Assessment Risk of Violence Known situational, environmental and dynamic risk factors, including intelligence from

clinical handover and recent ECR notes Historical – i.e. previous instances of use of force and the consumer’s response; Current physical health, and Multidisciplinary Team (MDT) discussions (see Identification, Mitigation and

Management of Aggression and Violence for Mental Health Justice Health Alcohol and Drug Services Inpatient Units Clinical Guideline and DMHU Clinical Risk Assessment and Management Procedure).

Examples of risks to consider include the consumer’s mental, psychological, physical and medical health or in the case of females, the possibility of pregnancy.

2.2 De-escalationWhen a situation develops or an incident occurs which may require the use force to be used against a consumer, the clinical staff must assess the situation and act to de-escalate the situation. This may include the following strategies: Communication and response Diversionary techniques Negotiation Reassurance, and Specific strategies identified in the consumer’s safety plan.

2.3 Physical RestraintWhere de-escalation has been unsuccessful, clinical staff should use endorsed VPM techniques. Where a consumer requires prone restraint for their safety, a minimum of five VPM staff are required in line with established best practice.

During physical restraint staff should continue communication with consumer to ensure their safety. The duration and position of restraint are monitored at all times to ensure the safety of the consumer and staff.

An Authorised Health Practitioner may direct a Security Officer, Allied Health Assistant or Assistant in Nursing, to assist if physical intervention is required. Security Officers will act under the direction of the Authorised Health Practitioner.

All instances of use of force must be documented (see section 5).

2.4 Forcible Giving of MedicationMedication is only ever forcibly given if all other efforts to de-escalate the consumer have been unsuccessful and the treating team considers that medication is immediately necessary for a consumer’s health and safety or the safety of others (see Identification, Mitigation and Management of Aggression and Violence for Mental Health Justice Health and Drug Services Clinical Guideline – Attachment 5 for more information).


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Security Officers may provide assistance in restraining a consumer on the request of an Authorised Health Practitioner. Such assistance may involve the incidental but reasonable use of force.

All instances of the forcible giving of medication must be documented (see section 5).

2.5 SeclusionSeclusion is only to be used as an intervention when all less restrictive methods for keeping a consumer and/or others safe have failed, or as an emergency measure in extreme circumstances to ensure the immediate safety of a consumer and/or others.

Seclusion must be authorised by a Consultant Psychiatrist if a seclusion is planned or as soon as practicable if initiation of seclusion is by the Nurse in Charge (NIC). Authorisation must be documented in the consumer’s electronic clinical record (ECR) (see Seclusion of Persons with Mental Illness or Mental Disorder Detained under the Mental Health Act 2015 Procedure).

A consumer who is to be secluded must be placed in the seclusion room in a safe manner, and with respect to their dignity as far as possible. The process of seclusion must be carried out by five VPM trained staff. Where the consumer being secluded is a female, at least one female staff member must be present.

Authorisation for seclusion from a Consultant Psychiatrist is valid from the time seclusion begins for a maximum of four hours. If the seclusion period needs to be extended, new authorisation must be sought from a Consultant Psychiatrist (see Seclusion of Persons with Mental Illness or Mental Disorder Detained under the Mental Health Act 2015 Procedure).

The consumer who is secluded must undergo a physical and mental health assessment every four hours by a Medical Officer. This assessment is to be documented in the consumer’s ECR and the seclusion register – see section 6 for further information.

Seclusion is only to continue as long as is required for the consumer’s own safety or the safety of others, and must be limited to the minimum time that is necessary and reasonable.

The Public Advocate of the ACT must be notified, using the Seclusion Form, found on the clinical forms register, when a consumer is secluded. The Seclusion Form must be forwarded to the Public Advocate within twelve hours by fax (6207 0688).

Each episode of seclusion must be recorded in the Seclusion Register, located in the registers draw in the Nurses Station (see section six and the Seclusion of Persons with Mental Illness or Mental Disorder Detained under the Mental Health Act 2015 Procedure for more information).

2.6 Use of Handcuffs inside DMHUThe use of handcuffs within DMHU is a clinical decision. Refer to attachment 1 for details.


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2.6.1 Who can authorise the use of handcuffs in the DMHUThe use of handcuff must be authorised by the ADON or NIC of the DMHU at the time, as follows: During business hours - in consultation with the Clinical Director, FMHS or the

Operational Director, Justice Health Service (JHS) After hours – in consultation with the MHJHDAS on-call Director in consultation with the

Security Supervisor In the case of emergency medical leave – the doctor authorising the medical leave, i.e.

the Clinical Director, FMHS; the DMHU Consultant Psychiatrist or the on-call Consultant Psychiatrist (after hours).


Section 3 – Care of a Consumer Post Use of Force

Any consumer on whom force has been used must be asked if they have sustained any injuries or if they require medical attention. Delegated clinicians (the Clinical Director, FMHS; Operational Director, JHS, Consultant Psychiatrists, On-Call Psychiatrists, ADON or NIC) must ensure that a Doctor examines a consumer injured by the use of force, or who requests medical treatment following the use of force as soon as practicable (s. 64 Mental Health (Secure Facilities) Act 2016).

The use of force can be a traumatic experience and staff should provide an empathetic debriefing to the consumer, their family, guardian, and nominated person as an integral part of post use of force practice. Staff must record the debriefing in the consumer’s ECR, including the content of the conversation, and responses from the consumer and/or their representative. If debriefing does not occur, the attempts to debrief and/or the rationale not to debrief must be recorded in the consumer’s ECR.

For issues relating to Aboriginal and Torres Strait Islander consumers, the Aboriginal and Torres Strait Islander Liaison Officer should be involved to assist in communication with the consumer and/or their family to help resolve any issues.


Section 4 – Care of Staff Post Use of Force

The ADON, CNC, NIC or Supervising Security Officer will notify the relevant Clinical Director or Security Supervisor or Clinical Director on-Call (after hours) of any injury to staff and ensure that a Riskman is completed.

An Authorised Health Practitioner, Security Officer or Escort Officer must ensure that any injuries sustained by staff during a use of force are photographed or recorded using an ACT Health approved mobile device (eg. hand held camera or phone). These images will form part of the Security report and will be uploaded into the Security Riskman Database.


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A post use of force debrief will be led by the ADON or Clinical Nurse Consultant (CNC) or NIC (after hours) at the conclusion of the incident. The aim of the debrief is to assess the immediate management and welfare needs of staff involved.

Within one week of the incident, the CNC will coordinate an extended debrief for all staff involved in the incident.

Any staff member who has been the victim of an assault has the right to report the assault to ACT Policing, and must be provided with the necessary support and advocacy to do so. If the staff member is unable to report the incident themselves, a report can be made on their behalf by the ADON, CNC or NIC.


Section 5 – Documentation Requirements for Use of Force

6.1 Use of Force RegistersUnder s. 64 of the Mental Health (Secure Facilities) Act 2016, a record must be kept of any incident involving the use of force. The registers include: The name of the consumer(s) involved in the incident The name of each person involved during the incident The date force was used on the consumer The rationale for the use of force The force used The injury caused; if any If someone died as a result of the use of force, the date and circumstances of the death Anything else the Director-General considers relevant, and Anything else prescribed by regulation.

These registers must be available for inspection for any Commissioner exercising functions under the Human Rights Commission Act 2005.

6.1.1 Clinical RegistersThe following registers, located in the registers draw in the nurses’ station, are used to document the use of force used in clinical settings, as appropriate: DHMU Seclusion Register (if the use of force occurred in the context of seclusion) DMHU Use of Force, Involuntary Restraint, Mechanical Restraint and Forcible

Giving of Medication Register.

6.1.2 Security Registers Security Officers or Court Security Officers involved in a use of force (including

handcuffs) or present at a use of force incident must document their involvement in a Riskman Security Activity Register before the end of their rostered shift. The only exception to this is if an employee/officer has been


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injured and released due to medical reasons (as above).

According to the Mental Health (Secure Facilities) Act 2016, he Riskman report must include: Details of persons involved (staff and consumers) Location of the use of force The circumstances i.e. the person was committing a violent or non-compliant act that

necessitated the use of force The orders/directives issued to the person, by whom and including the date and times The person’s response (verbal and/or physical) The type of force used by each Authorised Health Practitioner, Security Officer or Escort

Officer (e.g. applied a limb immobilisation technique and forced the person to the floor) – this must be detailed and include the types of force used from beginning to end of incident

Any restraints/handcuffs used Any medical attention required by and/or given to staff and who provided it That medical attention was offered and/or given to the person and the person’s

response to that offer The outcome of the use of force (e.g. person taken to seclusion room) and/or The reason(s) for the level of force used If someone died as a result of the use of force, the date and circumstances of the death Anything else the Director-General considers relevant; and Anything else prescribed by regulation.

6.2 Reporting Incidents of the Use of Force6.2.1 Public Advocate and Official VisitorsThe Mechanical, Physical Restraint or Forcible Giving of Medication Form, available on the clinical forms register, must include comprehensive details of the incident and its circumstances, the reasons for the decision to use force, and the kind of force used. The NIC must ensure that a copy of this record must be provided to the Public Advocate as soon as practicable after the incident. This record must be available for inspection by an ACT Human Rights Commissioner

6.2.2 RiskmanA clinical Riskman incident report must also be completed if the incident involved a consumer. The CNC, or NIC (after hours), is responsible for ensuring the use of force is reported in Riskman.

Where a Security Officer is involved in the use of force incident a report must be made on the Riskman Security Activity Register.

6.5 Review of Use of forces episodesAll episodes of physical restraint in DMHU must be reviewed in the DMHU Clinical Safety meeting (including outcomes and learnings from reviewed Riskman reports).


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The Operational Director, JHS and Health Security Operations Manager will be provided with minutes from DMHU Clinical Safety meetings.

The Operational Director, JHS and the Health Agency Security Advisor will review any incidents involving the use of force to ensure lawful compliance.

A report will be tabled at the Mental Health Justice Health Alcohol and Other Drug Services (MHJHADS) Divisional Work Health and Safety Committee meeting every three months.

6.6 Closed Circuit Television (CCTV) Footage or Other Camera FootageThe supervising Security Officer at DMHU will be responsible for obtaining any supporting CCTV footage and/or hand held camera footage relating to an incident of the use of force. Footage (from the CCTV surveillance) must be logged in the Closed Circuit Television Security Register and secured. Footage can be made available to the Unit Management Team for incident review and/or incident management.


Implementation This procedure will form part of the induction training for all Authorised Health Practitioners, Security Officers, Court Security Officers and Escort Officers engaged within the DMHU.


Related Policies, Procedures, Guidelines and Legislation

PoliciesACT Government Code of Practice for Closed Circuit Television Systems 2009ACT Health Protective Security PolicyACT Health Closed Circuit Television (CCTV) PolicyACT Health Policy Use of Force by Security OfficersCHHS Restraint of a Person - Adults Only PolicyDMHU Security Procedural FrameworkDMHU Use of Force Policy

ProceduresMHJHADS Unauthorised Leave of Admitted People from MHJHADS Inpatient Units ProcedureMHJHADS Seclusion of Persons with Mental illness or Mental Disorder Detained under the Mental Health Act 2015 ProcedureDMHU Leave ProcedureDMHU Search Procedure

Guidelines ACT Health Guidelines: Use of Force by Security OfficersACT Health Protective Security Guidelines


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Identification, Mitigation and Management of Aggression and Violence for Mental Health Justice Health and Drug Services Clinical Guideline

LegislationSecurity Industry Act 2003Court Procedures Act 2004Crimes Act 1900Guardianship and Management of Property Act 1991Mental Health Act 2015Mental Health (Secure Facilities) Act 2016Human Rights Act 2004Human Rights Commission Act 2005Powers of Attorney Act 2006


Definition of Terms

ACT Health Security Staff: is an employee of ACT Health who perform a security function within Health and posses a security license as defined in the Security Industry Act 2003.

Authorised Health Practitioner: is an AHPRA-registered health practitioner providing care or treatment for consumers who is authorised by the Director-General under the Mental Health (Secure Facilities) Act 2016. See the Mental Health (Secure Facilities) (Health Practitioners) Authorisation 2016 (No 1) on the ACT Legislation Register for more details.

Court Security Officer: is a Security Officer, appointed under the Court Procedures Act 2004, performing security duties in relation to an ACAT hearing within DMHU.

Escort Officer: is an authorised health practitioner under the Mental Health (Secure Facilities) Act 2016; or an authorised person under the Mental Health (Secure Facilities) Act 2016; or a police officer; or a corrections officer if the Corrections Director-General has agreed to the officer having

the function of escorting the person under this chapter; or a youth detention officer if the Children and Young People Director-General has agreed

to the officer having the function of escorting the person under s. 144F (c) of the Mental Health Act 2015.

Forcible Giving of Medication: is medication administered to a consumer against their will when under restraint. This is considered immediately necessary by the treating team for a person’s health and safety and/or the safety of others.

Restraint: is the interference with, or restriction of, an individual's freedom of movement. Restraint is defined as any device, material or equipment attached to or near a person’s body and which cannot be controlled or easily removed by the person and which


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deliberately prevents or is deliberately intended to present a person’s free body movement to a position of choice and/or a person’s normal access to their body. Restraint by threat is the direct or implied threat to use restraint against a person.

Seclusion: is involuntary placing of a consumer alone in a locked room from which free exit is prevented.

Security Officer: is an Authorised Officer appointed by the Director-General under s. 69 Mental Health (Secure Facilities) Act 2016.

Treating Team: includes the Medical Officer, Consultant Psychiatrist, Senior Nurse, nursing staff, Emergency Medicine Specialist, interdisciplinary team and other relevant healthcare providers.


Search Terms

Use of force, restraint, seclusion, handcuffs, escort

Attachment 1 – Use of Handcuffs

Attachment 1 – Use of Handcuffs

Disclaimer: This document has been developed by ACT Health, Canberra Hospital and Health Service specifically for its own use. Use of this document and any reliance on the information contained therein by any third party is at his or her own risk and Health Directorate assumes no responsibility whatsoever.

Date Amended Section Amended Approved ByEg: 17 August 2014 Section 1 ED/CHHSPC Chair


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Attachment 1 – Use of HandcuffsGeneralHandcuffs should never be used as a first-line response to an incident requiring the use of force unless the situation dictates, for example: The risk of harm or serious physical injury to anyone in the facility is very high due to the

level of aggression by a consumer There is no other means to control the situation, i.e. less restrictive measures have failed

or are not appropriate, or There is a risk of the consumer absconding.

Under no circumstances should handcuffs be used for the sole purpose of reducing the number of staff required to provide a safe escort.

Where handcuffs are used to manage the risk of serious physical harm, the person who authorised their use must authorise their removal as soon as the risk of serious physical harm has been resolved.

Only a Security Officer or Court Security Officer (see definition of terms) who has been trained and assessed as competent by an appropriate security industry training course in the use of handcuffs may employ the use of handcuffs. Only the handcuffing techniques approved in the security industry training course may be used.

Types of handcuffsSecurity Officers or Court Security Officers at the DMHU will use either Mark IV (chain) or Mark V (hinged) handcuffs.

Chain cuffs Hinged cuffs

Handcuff storage When not being used, handcuffs must be stored in a secure safe in the DMHU Security

Control Room. Handcuffs issued from the Security Control Room are to be kept in leather/canvas

handcuff pouches and MUST be worn on the Security Officers’ belt. Handcuffs are not to be kept in a Security Officer’s pocket or tucked into their belts. Except when handcuffs are applied to a consumer, handcuffs are not to be on public display outside of a handcuff pouch.


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General Guidance when handcuffing A pat down search of the consumer must be conducted before handcuffs are applied. Handcuffs must always be placed on the wrist, never forcibly applied. Careless use of

handcuffs may cause unnecessary injuries such as fractures to the wrist or nerve damage.

Generally, consumer escorts are conducted with the handcuffs applied to the wrists of the consumer with the consumer’s arms to the front of their body.

Only in circumstances where there has been an extreme act of violence or aggression (as previously outlined in this Attachment) within the DMHU facility, and the use of handcuffs were authorised, can a consumer be handcuffed with their arms behind their back, and only where if it is unsafe to handcuff the consumer any other way.

Note: Consumers are not to be escorted in a vehicle with their wrists handcuffed behind their back.

SAFLOK handcuffs should be applied with the keyhole facing upwards. Handcuffs must be a secure but comfortable fit. Once fitted, handcuffs must be double locked.

Advice and support on the use of handcuffs can be provided by Escort Officer or the ACT Health Agency Security Advisor.

Application of handcuffs Handcuffs must be applied out of the sight of other consumers. Before the handcuffs are applied Escort Officers must:

o Explain to the consumer why handcuffs are being used and how they will be applied.o Advise the consumer to walk slowly whilst handcuffed and not to run so as to

maintain their balance.o Search the consumer (refer to DMHU Search Procedure) before applying the

handcuffs. It is the responsibility of the Escort Officer applying the handcuffs to ensure that the

handcuffs are secure and comfortable for the consumer. One set of keys of the handcuffs must be retained by the Escort Officer who applied the

handcuffs, who must be present at all times. The second Escort Officer will also have a set of handcuffs and a separate key. Any other reserve keys to the handcuffs in use must be kept locked in the handcuffs locker in the DMHU Security Control Room.

Whist being escorted in a vehicle, at no time must the consumer be secured by the handcuffs to any vehicle fixtures or fittings.

On return to the DMHU the handcuffs must be removed within the Secure Vehicle Entry (SVE) well out of sight of other consumers.

After handcuffs are removed, the consumer should be examined by the NIC of the escort to assess if any injury has been sustained by the consumer.


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Methods of HandcuffingHandcuffing to the front (compliant cuffing)

Single handcuffed – a consumer being handcuffed on their own

Double handcuffed – consumers is handcuffed to a Security Officer using two sets of handcuffs

Hand cuffing to the rear (non-compliant cuffing)

Non-compliant handcuffing-Standing Non-compliant handcuffing-ground position


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Handcuffing a consumer to the rear will only be undertaken in exceptional circumstances where the consumer has been engaged in an extremely violent or assaultive interaction which has necessitated physical intervention by Authorised Health Practitioner, Security Officer or Escort Officer and where there is no other means available to ensure the safety of ALL staff involved and no other way to restrain, the consumer. Once the consumer has been restrained on the ground, their arms are to be brought together behind their back and the handcuffs applied.

Once an Authorised Health Practitioner authorises that the consumer be moved, they are to be escorted back to their room or seclusion room nominated. Once escorted to the secure area, the handcuffs are to be removed immediately, unless directed otherwise by the Authorised Health Practitioner.

Refusal by a Consumer to Comply with HandcuffsIf the consumer to be escorted with handcuffs refuses to have them applied, the leave plan must be reviewed urgently by the Clinical Director, FMHS. The following options should be considered: Cancellation / postponement of escort Requesting ACT Policing assistance, or Application of the handcuffs while consumer is restrained.

Use of handcuffs During an escort Where there is a requirement to handcuff a consumer to an Escort Officer (such

as on an aircraft or medical appointment escort) every effort should be made to ensure that the Escort Officer, handcuffed to the consumer is of the same sex and similar height as the consumer.

In exceptional circumstances, where this is not possible, a risk assessment plan should be completed by the MDT authorising the consumer to be handcuffed to an Escort Officer of the opposite sex.

When using handcuffs all escort officers and clinical staff must monitor the physical and mental state of the consumer to prevent any injury to either party.

When a consumer is undergoing an ambulance escort/transfer (refer to the DMHU Escort Role of Security Procedure), if deemed necessary in accordance with these procedures, or at the direction of the Ambulances Officers, the con-sumer may be handcuffed to the ambulance bed trolley whilst being transpor-ted to hospital. If the consumer is injured in a way that does not allow handcuffs to be applied, consideration of other restraint methods (such as leather cuffs) may be required.

When a consumer is to be handcuffed to an Escort Officer, the consumer’s dominant wrist should be handcuffed to the staff Escort Officers’ non-dominant wrist. The handcuff must be applied to the consumer first. Removal of handcuff when the consumer is


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handcuffed to an Escort Officer must be from the Escort Officer first. The Authorised Health Practitioner in charge of the escort will never be handcuffed to the consumer.

An Escort Officer must do regular checks of the handcuffs on the consumer, especially the wrist areas. Should handcuffs need to be adjusted, caution should be exercised. Removal of handcuffs must only occur in exceptional circumstances. If a consumer needs to use a toilet during the escort, the Authorised Health Practitioner in charge of the escort will need to decide whether the handcuffs can be temporarily removed for this purpose.

Note: Handcuffs should only ever be removed if it is safe to do so.

Removal of handcuffs at the destination must only happen when the consumer is securely housed in another facility or location. Vigilance must be maintained at all times and the consumer must never be without the escorting officer. Handcuffs must be reapplied prior to the return journey.

The privacy and dignity of the consumer must be respected at all times whenever handcuffs are deployed. Handcuffs must be applied out of sight of other consumers. This can be aided by placing a shirt, jumper etc over the handcuffs when being escorted in public.

If the use of handcuffs have been authorised for use on a pregnant female consumer, particular attention must be given to how the consumer is managed when being escorted (such as assistance when getting in and out of an escort vehicle, toilet breaks etc). Also see DMHU Escort Procedure (Pregnant Consumers).

At Hospital When a handcuffed consumer is attending hospital for a medical assessment or

treatment, handcuffs should only be removed (if deemed safe to do so) upon the request of the examining doctor or nurse to facilitate the examination, in-vestigation or treatment.

In such circumstances the consumer should remain un-handcuffed for the shortest possible time.

If a consumer is admitted to hospital as an inpatient, and their Security Cat-egory and Leave Entitlement (SCALE) assessment (refer to DMHU Leave Pro-cedure) indicates that the ongoing use of handcuffs is required, the consumer must remain handcuffed to the bed rails. This is to be authorised by the Clinical Director, FMHS.

At CourtConsumers appearing at court/tribunal should not normally be handcuffed within the court room. If handcuffs are used while transporting a consumer to court/tribunal, they should be removed immediately before the consumer is escorted into the courtroom unless the magistrate or member directs otherwise.


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