Recognising that consumers' self-determination is a vital part of successful treatment and recovery, the principles of recovery emphasise choice and self-determination within medico-legal requirements and duty of care. Striking a balance requires an understanding of the complex and sometimes discriminatory nature of the goal of reducing all harmful risks (Slade 2009a, pp. 176–179). Services must manage various tensions including:
- maximising choice
- supporting positive risk-taking
- the dignity of risk
- medico-legal requirements
- duty of care
- promoting safety.
Australia's National Mental Health Seclusion and Restraint Project (NMHSRP) 2007–09 promoted discussion and action to reduce seclusion and restraint. The 11 Beacon demonstration sites established as part of the project demonstrated that simple changes can lead to major improvements. The following strategies were identified as influencing positive outcomes to reduce seclusion: leadership to effect organisational change, the use of data to inform practice, investment in workforce development and debriefing techniques involving people with a lived experience, their carers and staff.
Australian state and territory governments as well as professional associations embraced the objectives of the NMHSRP and reviewed their policies and practices.
There is a detailed discussion of recovery, self-determination and safety in A national framework for recovery-oriented mental health services: Guide for practitioners and providers.