Prevalence and predictors of restrictive interventions in a youth‐specific mental health inpatient unit

Abstract

Introduction The use of restrictive interventions is one of the most controversial practices in medicine. They are utilized in an inpatient setting to manage agitated or aggressive behaviour or to ensure that an individual receives the necessary treatments. However, restrictive interventions remove autonomy and adverse events can be associated with their practice. Youth‐specific inpatient units (IPUs) are now being established and it is imperative that the use of restrictive interventions is reduced. In order to inform and facilitate prevention and reduction strategies, this study aimed to determine the prevalence and determinants of restrictive interventions (restraint, seclusion and medication without consent) in a youth specialist mental health IPU. Methods This study was set at a 16‐bed youth specialist acute IPU of Orygen Youth Health, a specialist youth mental health service that provides inpatient care for those aged 18 to 25 years within a catchment area of west and north‐western regions of Melbourne, Australia. A retrospective file audit was conducted of all the admissions to the unit from 01 January 2015 to 30 June 2015. Results Over the 6‐month study period, 159 young people were admitted and this accounted for 188 admissions. Over half (54.3%) of admissions were involuntary and restrictive intervention were used in 17.6% of admissions. Specifically, 15.7% (N = 25) of young people experienced restraint, 10.1% (N = 16) were secluded, and 8.1% (N = 12) experienced medication without consent. Absent insight and involuntary status on admission were associated with restrictive interventions. Conclusion As youth mental health services develop, interventions aimed at reducing restrictive interventions are needed.

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“…Behavioural escalation within this population has been linked to historical experiences of trauma such as abuse or neglect, and consequently a reduced ability to self-regulate emotions (Ford et al , 2006; Fratto, 2016). Occasionally, such incidents can precipitate restrictive interventions such as physical restraints or separation with the aim of reducing harm (Goz et al , 2019). Unfortunately, such practices themselves can result in physical and psychological harm to the young people, and to the staff (Huckshorn, 2006; Lozano, 2020).…”

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“…The United Nations (UN) Convention on the Rights of the Child states that depriving a child of liberty is acceptable only as a last resort, for the shortest appropriate time, as appropriate to their well‐being, and proportionate to the circumstances (Nowak, 2019 ). The use of RP is permitted in many children's institutional settings (Children's Commissioner, 2018 ; Cunneen et al, 2017 ; Department for Education and Department of Health and Social Care, 2019 ; Goz et al, 2019 ; Nowak, 2019 ; United Nations Committee on the Rights of Persons with Disabilities, 2017 ; Wanglar, 2021 ). Restraint may involve manual or mechanical restraint (including pain‐inducing techniques) and, in health settings, the use of forced medication (Kaltiala‐Heino et al, 2007 ; Lüdtke et al, 2018 ; Taylor, 2020 ).…”

“…Data from 2013 suggested an estimated 50% or more of children in the UK learning disability services had experienced RP (Health and Social Care Information Centre, 2013 ). More recently, the use of RP in an Australian youth mental health unit was recorded in 17.6% of admissions over a 6‐month period (Goz et al, 2019 ). There is some evidence that girls are more likely to be restrained than boys, and to be restrained face‐down (Agenda: Alliance for Women and Girls at Risk, 2017 ).…”

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“…Despite this, across the world, there are limited inpatient mental health units that are dedicated to young adults and provide specialised assessment and treatment (Goz et al . 2019). One mental health inpatient facility in Australia, however, caters exclusively for young adults.…”

“…Further, rather than aggregating adults and young adults together, evidence-based interventions recommend that a unique approach tailored to this life stage be adopted for those between 18 and 25 with personality disorders (Project Air Strategy for Personality Disorders 2015). Despite this, across the world, there are limited inpatient mental health units that are dedicated to young adults and provide specialised assessment and treatment (Goz et al 2019). One mental health inpatient facility in Australia, however, caters exclusively for young adults.…”