National policies aimed at reducing the use of the restrictive methods will fail unless mental health units are better resourced and nurses armed with effective alternatives, according to a groundbreaking report by the Australian College of Mental Health Nurses.

The restrictive practices were traumatic for nurses and patients alike, but necessary on understaffed, overcrowded and poorly designed mental health units when psychiatric or drug-affected patients became aggressive, the research project found.

"Nurses don't want to use seclusion or restraint but they don't have alternatives under certain circumstances," said ACMHN chief executive Adjunct Associate.

"The feel they are just running around trying to keep everything ticking along."

Just under half of mental health nurses (46 per cent) did not believe seclusion and restraint could be completely eliminated, found the survey of 500 nurses working on psychiatric units and in emergency departments across Australia.

NSW chief psychiatrist Murray Wright is currently conducting a statewide review into restrictive practices in mental health units sparked by disturbing CCTV footage from Lismore Base Hospital showing Miriam Merten who died after she was locked, naked and chemically restrained, in a seclusion room in 2014.

Dr Wright said the ultimate goal was to eliminate seclusion "the treatment of last resort" altogether.

But lead researcher Professor Eimear Muir-Cochrane said "the range of techniques needed to eliminate seclusion are just not available to mental health nurses".

Nurses were "stuck between a rock and a hard place trying to provide the best, least restrictive care, but also maintain safety for everyone on the ward," said the chair of Nursing (mental health) at Flinders University.

"The bottom line is when there aren't enough highly skilled staff, they're overworked, or the acuity of patients is very high, nurses need to use [seclusion and restraint] to maintain safety on the ward."

No jurisdiction in the world had successfully eliminated restraint, Professor Muir-Cochrane said.

"It's inevitable that at some point there would still be a need at some point to restraint [patients] to stop harming themselves or others," though they were not common, she said.

The research offered invaluable insight considering mental health nurses were involved with most instances of seclusion (defined as deliberately confining a patient alone in a room or area) and restraint (using hand-on force to immobilise a patient and restrict their freedom of movement).

More than one in five did not feel safe at work, 20 per cent were worried about their safety at work, and 31 per cent felt unsafe around aggressive patients, according to the project funded by the National Mental Health Commission.

"We need to address the fact that nurses need to feel safe at work and other consumers on ward are safe," Professor Ryan said.

Nurses were increasingly the victims of verbal and physical abuse in emergency departments, psychiatric units and patient's family members, Professor Muir-Cochrane said.

Nurses said highly agitated and violent drug-afflicted patients are being "shunted" from emergency departments to mental health units.

One mental health nurse described a drug-affected male patient smashing a nurse's station window with an exercise bike, and a second incident involving a patient who said he was going to kill someone and attempted to choke a security officer.

Another nurse described a 196cm young and fit patient ripping the metal hinge off the back of his door and threatening to "take the heads off other patients and staff if anyone came near him".

"It is the rare occasions like this that I believe seclusion is needed," the nurse wrote.

They recommended improving training in less restrictive interventions, one-to-one nursing and sitting with agitated patients in quiet areas "but to eliminate seclusion completely in my view is going to be potentially a dangerous move," she said.

Even new psychiatric facilities were often poorly designed and could exacerbate the agitation of already tense and vulnerable patients, Professor Muir-Cochrane said.

"They don't have the space they require. They're often noisy and overcrowded when what they need is a quiet, calming environment," to help avoid behaviour escalating to the point where seclusion or restraint become the last resort option."

The research project found nurses did not believe the techniques were overused on their wards, but some staff were more willing to use seclusion and restraint than others.

In some instances, the techniques were used punitively, the report suggested.

Commenting on the findings, one consumer told the researchers "I do believe sedation and restraint are at times done punitively not because there's a 'nursing or medical reason' to do it, [and] not just because of understaffing".

The report makes 13 recommendations including the NHMC convening an implementation group to address the issues, requiring all nurses working in mental health to undertake formal post graduate mental health qualification and training in de-escalation techniques, greater supervision, mentoring and support, and better resourcing in mental health units.

The research project was released at the International Mental Health Nurses Conference in Hobart.