Coercive measures in psychiatry – When do they occur and who is at risk?

Cole, C. L.; Klotz, Eva; Junghanss, Julia; Oster, A.; Vandamme, Angelika; Bermpohl, Felix; Mahler, Lieselotte

doi:10.1016/j.jpsychires.2023.06.026

Cited by 5 publications

(5 citation statements)

References 24 publications

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“…The findings show that people who experience seclusion in Aotearoa New Zealand's acute inpatient mental health services often do so within the first 24 h following admission. This corroborates previous research indicating this early timeframe has important practice implications for preventing and eliminating the use of seclusion (Cole et al, 2023;El-Badri & Mellsop, 2002;Georgieva et al, 2012;Happell & Gaskin, 2011;Jury et al, 2019;Trauer et al, 2010). The variation between geographic regions shows there are potentially differing practices across inpatient services (Lai et al, 2019).…”

Section: Discussionsupporting

confidence: 87%

“…Another Australian study indicates one quarter (25%) of first seclusion activity began within the first hour (Trauer et al, 2010). In other parts of the world, a study in the Netherlands found 58% of coercive measures (seclusion and/or restraint) occurred on the same day as admission (Georgieva et al, 2012) and a study in Berlin found that 72% of cases that experienced coercive measures, did so within 24 h of admission (Cole et al, 2023). Thus, the first 24 h following inpatient admission is a critical period and potential contributing factors warrant further investigation.…”

Section: Introductionmentioning

confidence: 99%

“…The use of seclusion and other restrictive interventions is often associated with staff perceptions of aggression or threatening behaviour, substance intoxication and diagnoses (Beames & Onwumere, 2022;Cole et al, 2023;Noorthoorn et al, 2015;Stepanow et al, 2019).…”

Section: Introductionmentioning

confidence: 99%

“…People perceived as agitated or aggressive prior to or during admission are significantly more likely to experience restrictive practices during the inpatient stay Cole et al, 2023;Hotzy et al, 2018;Jury et al, 2019). Problematic substance use is also associated with seclusion (Jury et al, 2019;McLeod et al, 2017).…”

Section: Introductionmentioning

confidence: 99%

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Seclusion within the first 24 h following admission into inpatient mental health services and associations with referral pathways, recent service contact and HoNOS ratings

Lai,

Jury,

Tuason

et al. 2023

Psychiatric Ment Health Nurs

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Accessible SummaryWhat is known on the subject? Seclusion is a harmful and traumatising intervention for people accessing mental health services. People who are subject to seclusion in inpatient mental health services often first experience this within the first 24 h following admission. There is limited research examining how recent contact with services impacts the likelihood of seclusion when people are admitted to inpatient services. What the paper adds to existing knowledge? Males, Māori and Pasifika experience higher rates of seclusion within the first 24 h following inpatient admission. People perceived by clinicians as overactive, aggressive, disruptive or agitated are seven times more likely to be secluded within the first 24 h. People referred from police or justice services are three times more likely to be secluded within the first 24 h. People who had frequent contact with community mental health services prior to inpatient admission were less likely to be secluded. What are the implications for practice? The first 24 h of inpatient admission is a critical focus for eliminating the use of seclusion. Initial interactions with people recently admitted should focus on nurturing relationships and reducing distress. Mental health staff should consider the person's cultural needs, referral pathway, recent service contact and baseline ratings on the Health of the Nation Outcomes Scales (HoNOS) when working proactively to prevent the use of seclusion in the first 24 h following admission. Strengthening the focus on nurturing relationships, cultural understanding and non‐coercive de‐escalation approaches requires leadership support and strategic workforce development. AbstractIntroductionPeople who experience seclusion in inpatient mental health services often do so within the first 24 h following admission. There is limited research examining the potential contributing factors, particularly recent contact with services.Aim/QuestionTo identify factors associated with seclusion within the first 24 h following admission into acute inpatient mental health services.MethodA retrospective analysis was undertaken using routinely collected data from Aotearoa New Zealand mental health services.ResultsA higher likelihood of seclusion within the first 24 h following admission was associated with: males, Māori, Pasifika, referrals from police/justice services, inpatient transfers, recent contact with crisis assessment teams and clinician perceptions of aggression, problematic substance use, cognitive problems and hallucinations or delusions. Recent contact with community mental health services was associated with a lower likelihood.DiscussionPeople's cultural needs, referral pathway, recent service contact and HoNOS scores should be considered when working to prevent the use of seclusion in the first 24 h following admission.Implications for PracticeThe first 24 h following inpatient admission is a critical period for preventing the use of seclusion. Nurturing relationships, cultural understanding and use of non‐coercive de‐escalation approaches can support better outcomes for people recently admitted.

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Section: Discussionsupporting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Seclusion within the first 24 h following admission into inpatient mental health services and associations with referral pathways, recent service contact and HoNOS ratings

Lai,

Jury,

Tuason

et al. 2023

Psychiatric Ment Health Nurs

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“…Nähern wir uns der alltäglichen Problematik aus einer klinischen Perspektive an, so ist zunächst die Frage der Zuständigkeiten, unter der Prämisse des gesellschaftlichen und politischen Auftrags für die Notfallversorgung, zu klären [17,18].…”

Section: Introductionunclassified

Psychiatrie ohne Zwang

Theodoridou,

Jäger

2023

Nervenheilkunde

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ZUSAMMENFASSUNGZwang in der Psychiatrie stellt ein anhaltendes Problem dar und wird national wie international kritisch diskutiert. Trotz aller Bemühungen gelang es bisher nicht, die Zahl der Zwangsmaßnahmen zufriedenstellend zu reduzieren. Die Gründe hierfürsind vielschichtig und komplex. Die gesellschaftlichen Entwicklungen fordern das psychiatrische Gesundheitssystem heraus und führen zu einer Zunahme der kontroversen Diskussion über die zugrunde liegenden medizinisch-psychiatrischen, ethischen und juristischen Annahmen und Überzeugungen. Angesichts des bestehenden Dilemmas diesbezüglich ist eine weitere Optimierung der Prävention und Reduktion von Zwangsmaßnahmen in der Psychiatrie dringend nötig. Die Neuordnung der Zuständigkeiten im Notfall kann in Kombination mit einer Strategie wie der vorgestellten „Zero-Coercion“-Initiative hierbei eine „Katalysatorfunktion“ übernehmen und die Entwicklung von Alternativstrategien ermöglichen, die in einer festgefahrenen Rollenverteilung nicht erkannt werden können.

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