Measures to Avoid Coercion in Psychiatry and Their Efficacy

Hirsch, Sophie; Steinert, Tilman

doi:10.3238/arztebl.2019.0336

Cited by 54 publications

(77 citation statements)

References 261 publications

(210 reference statements)

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“…The findings of this study broadly agree with the scientific literature, which emphasize that a combination of interventions to minimize the use of CM is necessary both individually and in terms of the involved organization, as well as the adoption of complex highly evidenced models [17,21,22,24,27,32,36,41].…”

Section: Discussionsupporting

confidence: 88%

Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review

Fernández-Costa

Gómez‐Salgado

Fagundo-Rivera

et al. 2020

JCM

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Coercive measures are a highly controversial issue in mental health. Although scientific evidence on their impact is limited, they are frequently used. Furthermore, they lead to a high number of ethical, legal, and clinical repercussions on both patients, and professionals and institutions. This review aims to assess the impact of the main alternative measures to prevent or limit the use of coercive measures with restraints in the management of agitated psychiatric patients. The research was conducted following the guidelines recommended by PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) in Medline, Cochrane Library, CINAHL, Web of Science, PsycInfo, LILACS, and Health Database of records between 2015 and 2020. After a critical reading, 21 valid articles were included. Both simple interventions and complex restraint programs were evaluated. Training in de-escalation techniques, risk assessment, and implementation of the “six core strategies” or “Safewards” program were the most assessed and effective interventions to reduce aggressive behaviors and the use of coercive measures. According to the revised literature, it is possible to reduce the use of restraints and coercive measures and not increase the number of incidents and violent behaviors among the patients through a non-invasive and non-pharmacological approach. However, further research and further randomized clinical trials are needed to compare the different alternatives and provide higher quality evidence.

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Section: Discussionsupporting

confidence: 88%

Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review

Fernández-Costa

Gómez‐Salgado

Fagundo-Rivera

et al. 2020

JCM

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“…Reducing the use of coercive interventions in in-patient psychiatry has been a major issue of interest in many countries. A considerable range of interventions has proven some efficacy in controlled studies [1]. However, evidence is still inconsistent also for highly favoured interventions such as de-escalation training and joint crisis plans [2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Reduction of coercive measures under routine conditions in psychiatric hospitals 2004–2019: Strong effects in old age psychiatry, much less in general psychiatry

et al. 2020

Self Cite

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Background: Many interventions to reduce the use of seclusion and restraint have been suggested in the last decades. Evidence-based interventions in old age psychiatry are different from those in general psychiatry. Evidence under conditions of routine care is generally scarce. A common data base for psychiatric hospitals introduced in 2004 allowed to examine the use of seclusion and restraint in different patient groups over 16 years under routine conditions. Methods: A registry for coercive measures in the Federal State of Baden-Wuerttemberg is available since 2015 and comprises all 32 hospitals licenced to admit involuntary patients. A study group had collected data prospectively since 2004 from a subsample of these hospitals. We analysed the mean percentage of patients subjected to coercive measures and the mean cumulative duration of these interventions in ICD-10 diagnostic groups in psychiatric hospitals from 2004-2019 among a total of 1,038,239 admissions. Results: The proportion of cases affected by coercive measures dropped significantly from 28.4 % to 10.5 % in patients with ICD-10 F0 disorders, while rates in patients with other diagnoses decreased insignificantly from 7.0 % to 5.4 %. The cumulated duration of coercive measures per affected case also dropped significantly among patients with F0 disorders, while changes in patients with other diagnoses remained insiginficant. Conclusions: The use of coercive measures in patients with organic disorders could be reduced by about 50 % in a State of 11 million inhabitants within 15 years, while in contrast no substantial reduction occurred among all other diagnostic groups. Specific interventions to reduce coercive interventions seem to be particularly successful for this patient group.

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“…Prevalence numbers like these of course don´t say anything about the necessity and adequacy of the coercive measures employed. But as coercive measures constitute a violation of patients’ human rights and are often experienced as such by patients [ 4 , 29 , 43 ], as they can have serious adverse effects ranging from emotional trauma to severe physical injury [ 3 , 4 , 26 , 51 ] and as attitudes towards physical violence, both in society in general and in the institutional context, have changed over time [ 30 ], efforts are made both in research and clinical practice to identify strategies to reduce coercive measures [ 8 , 15 , 18 ] and to make the measures more understandable for patients, e.g. by patient information.…”

Section: Introductionmentioning

confidence: 99%

Violence against children and adolescents by nursing staff: prevalence rates and implications for practice

Hoffmann

Clemens

König

et al. 2020

Child Adolesc Psychiatry Ment Health

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Background International studies show that child maltreatment is a widespread but often underestimated problem that causes high individual, social and economic costs. Child maltreatment is an important topic for the medical sector as well. On the one hand, affected persons often seek support and help from healthcare professionals, but on the other hand, assaults can also occur in medical institutions by healthcare professionals. Surprisingly, there is hardly any data on the frequency of child maltreatment by healthcare professionals in general and particularly by nursing staff. Methods Therefore, in a large representative survey of the German population of 2,516 subjects aged between 14 and 91, the experience of child maltreatment in medical institutions by nursing staff was assessed retrospectively. Results Of the 46 subjects who had an inpatient stay in a child and adolescent psychiatry before the age of 18, 33.3% reported to have experienced maltreatment by nursing staff, while 17.3% of the 474 persons who had an inpatient stay in general or pediatric hospitals experienced maltreatment by nursing staff. All forms of maltreatment were significantly more frequent in psychiatric compared to general and pediatric hospitals. Conclusions The results of our representative retrospective survey demonstrate that maltreatment by nursing staff are not rare individual cases, but that medical facilities bear systemic risks for assault. Therefore, it is necessary that all medical institutions, in particular psychiatric hospitals, address this issue. In order to reduce the risk for assaults, it is important not only to implement structural measures but also to develop an attitude that emphasizes zero tolerance for violence against children and adolescents.

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Measures to Avoid Coercion in Psychiatry and Their Efficacy

Cited by 54 publications

References 261 publications

Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review

Alternatives to the Use of Mechanical Restraints in the Management of Agitation or Aggressions of Psychiatric Patients: A Scoping Review

Reduction of coercive measures under routine conditions in psychiatric hospitals 2004–2019: Strong effects in old age psychiatry, much less in general psychiatry

Violence against children and adolescents by nursing staff: prevalence rates and implications for practice

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