A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics

Abstract

BackgroundPrevious research on mental health care has shown considerable differences in use of seclusion, restraint and involuntary medication among different wards and geographical areas. This study investigates to what extent use of seclusion, restraint and involuntary medication for involuntary admitted patients in Norwegian acute psychiatric wards is associated with patient, staff and ward characteristics. The study includes data from 32 acute psychiatric wards.MethodsMultilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization.ResultsThe total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint.ConclusionsThe substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors.

Use of mechanical and pharmacological restraint over an eight-year period and its relation to clinical factors

“…However, comparing these results is difficult because the number of inhabitants is not given in the Swiss study, and in our hospital, seclusion is not used. Others report the frequency of restraint among patients involuntarily admitted [23] or present studies based on wards not otherwise specified [28,29]. To our knowledge, there are no reliable numbers regarding the actual use of restraint per inhabitant.…”

“…Executing coercion and restraint is also stressful for the health-care personal. Patient's characteristics reported to influence the use of restraint vary but include the patient's diagnosis [11,[18][19][20][21], younger age [20,22], immigrant background [20], and aggressive or self-harming behavior [23]. Reports on the effect of gender vary.…”

Substance abuse in patients admitted voluntarily and involuntarily to acute psychiatric wards: a national cross-sectional study

“…Very few patients may have had more than one admission in the 3-month inclusion period. Thirty-five percent of patients were involuntarily admitted to the hospital [22].…”

Shielding in Mental Health Hospitals

“…In Norway, shielding is understood as both a treatment and a control (Husum, 2011;Norvoll, 2007;Vaaler et al, 2006;Norwegian Mental Health Act, 1999). Mechanical restraints that prevent a patient's freedom of movement (including belts, straps, and special clothing to prevent injury), short-term confinement behind a locked or closed door with no staff present (isolation, seclusion), involuntary medication as an acute intervention in crisis, and short retention are, however, described as coercion (Husum, 2011;Husum, Bjørngaard, Finset, & Ruud, 2010;Norwegian Mental Health Act, 1999). These methods are enshrined in legislation and require a separate administrative decision; they can be used only when absolutely necessary to prevent the patient from injuring himself or herself, or others, or to prevent serious damage to buildings, clothing, furniture, or other things (Norwegian Mental Health Act, 1999).…”