Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics

Abstract

Background Epidemiological studies have demonstrated considerable differences in the use of coercive measures among psychiatric hospitals; however, the underlying reasons for these differences are largely unclear. We investigated to what extent these differences could be explained by institutional factors. Methods Four psychiatric hospitals with identical responsibilities within the mental health care system, but with different inpatient care organizations, participated in this prospective observational study. We included all patients admitted over a period of 24 months who were affected by mechanical restraint, seclusion, or compulsory medication. In addition to the patterns of coercive measures, we investigated the effect of each hospital on the frequency of compulsory medication and the cumulative duration of mechanical restraint and seclusion, using multivariate binary logistic regression. To compare the two outcomes between hospitals, odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated. Results Altogether, coercive measures were applied in 1542 cases, corresponding to an overall prevalence of 8%. The frequency and patterns of the modalities of coercive measures were different between hospitals, and the differences could be at least partially related to institutional characteristics. For the two hospitals that had no permanently locked wards, certain findings were particularly noticeable. In one of these hospitals, the probability of receiving compulsory medication was significantly higher compared with the other institutions (OR 1.9, CI 1.1–3.0 for patients < 65 years; OR 8.0, CI 3.1–20.7 for patients ≥65 years); in the other hospital, in patients younger than 65 years, the cumulative duration of restraint and seclusion was significantly longer compared with the other institutions (OR 2.6, CI 1.7–3.9). Conclusions The findings are compatible with the hypothesis that more open settings are associated with a more extensive use of coercion. However, due to numerous influencing factors, these results should be interpreted with caution. In view of the relevance of this issue, further research is needed for a deeper understanding of the reasons underlying the differences among hospitals.

Open Doors by Fair Means: a quasi-experimental controlled study on the effects of an open-door policy on acute psychiatric wards

“…Further, coercive measures, that were not allowed to be used to prevent absconding, occurred with roughly the same frequency in all participating wards during intervention period. That means that an open-door policy is not necessarily accompanied by more coercive interventions, as suggested by a recent study from four hospitals in Germany [ 21 ], but neither is there enough evidence to claim the opposite [ 11 ].…”

Der Einfluss des Behandlungsvolumens psychiatrischer Kliniken auf das Risiko der Anwendung besonderer Sicherungsmaßnahmen

“…Dies verwischt Effekte in der Anwendung von bSm beim individuellen Fall. Anzahl und Dauer von bSm ist, wie sich auch in anderen Studien zeigt, auf Fallebene eher nicht normal verteilt, sondern sind eher wenige Fälle, die eine große Anzahl von bSm erhalten und viele, die nur einmal eine Maßnahme erhalten 19 .…”

“…Möglich wären systematische Verzerrungen unter der Voraussetzung, dass Fixierung und Isolierung sich grundlegend in Bezug auf Episodenhäufigkeit und Dauer unterscheiden würden. Hinweise hierfür liegen aus anderen Studien vor, in dem Sinn, dass Isolierungen tendenziell länger angewendet werden als Fixierung [19,22]).…”

Factors associated with prolonged episodes of mechanical restraint in mental health hospitalization units in Andalusia

“…Several studies have focused on the duration of restrictive interventions (El-Abidi et al, 2021;Gildberg et al, 2015;Guzman-Parra et al, 2015;Happell & Gaskin, 2011;Janssen et al, 2013;Narita et al, 2019;Noda et al, 2013;Porat et al, 1997;Tyrer et al, 2012), and they found different characteristics associated with the long duration of coercive interventions. Although the use of mechanical restraint and seclusion is increasingly regulated in theory, this is not always the case in practice and there is a lot of variability in its use and duration, even between institutions located in the same region (Janssen et al, 2013;Mann et al, 2021). For example, the study of Happell and Gaskin (2011) in 11 mental health services in Australia found that more than half of the episodes of seclusion lasted for less than two hours and the mean time of seclusion was three hours and three minutes.…”