Demographic and clinical characteristics impact the use of restrictive interventions in an adolescent inpatient unit. A retrospective cohort study.

Abstract

In adolescents admitted to mental health inpatient units, restrictive interventions are associated with a risk of physical and psychological harm. Mental Health policy and legal frameworks advocate least restrictive options and there is a drive to reduce the use of restrictive interventions in inpatient units. There is insufficient evidence pertaining to the characteristics of UK adolescents who are at risk of experiencing restrictive interventions within general adolescent mental health units. This study aimed to determine whether demographic and clinical characteristics are associated with the use of restrictive interventions or with the type of restrictive interventions. A retrospective cohort study was conducted using routinely collected data from a general adolescent unit in the National Health Service (NHS) in England, UK, over a 2-year period (1st January 2021 to 31st December 2022). There were three key findings. Of the 122 adolescents admitted, 46(38%) experienced restrictive intervention. Characteristics associated with the increased use of restrictive interventions included diagnosis of behavioural and emotional disorders and being a child looked after by the local authority. Being male was significantly associated with seclusion and being a child looked after was significantly associated with the use of physical and chemical interventions. These findings have important implications for policy and practice; they highlight the need for careful consideration by professionals, as to whether the needs of adolescents with these particular attributes are indeed best met within an inpatient unit, or whether the risks of admission including the increased risk of restrictive intervention outweigh the potential benefits. Also, further consideration of the most appropriate strategies for reducing restrictive interventions when admissions are appropriate or unavoidable, is required.