Trends in the use of coercive measures in Finnish psychiatric hospitals: a register analysis of the past two decades

Abstract

Background Coercive measures is a topic that has long been discussed in the field of psychiatry. Despite global reports of reductions in the use of restraint episodes due to new regulations, it is still questionable if practices have really changed over time. For this study, we examined the rates of coercive measures in the inpatient population of psychiatric care providers across Finland to identify changing trends as well as variations in such trends by region. Methods In this nationwide registry analysis, we extracted patient data from the national database (The Finnish National Care Register for Health Care) over a 20-year period. We included adult patients admitted to psychiatric units (care providers) and focused on patients who had faced coercive measures (seclusion, limb restraints, forced injection and physical restraints) during their hospital stay. Multilevel logistical models (a polynomial model of quadratic form) were used to examine trends in prevalence of any coercive measures as well as the other four specified coercive measures over time, and to investigate variation in such trends among care providers and regions. Results Between 1995 and 2014, the dataset contained 226,948 inpatients who had been admitted during the 20-year time frame (505,169 treatment periods). The overall prevalence of coercive treatment on inpatients was 9.8%, with a small decrease during 2011–2014. The overall prevalence of seclusion, limb restraints, forced injection and physical restraints on inpatients was 6.9, 3.8, 2.6 and 0.8%, respectively. Only the use of limb restraints showed a downward trend over time. Geographic and care provider variations in specific coercive measures used were also observed. Conclusions Despite the decreasing national level of coercive measures used in Finnish psychiatric hospitals, the overall reduction has been small during the last two decades. These results have implications on the future development of structured guidelines and interventions for preventing and more effectively managing challenging situations. Clinical guidelines and staff education related to the use of coercive measures should be critically assessed to ensure that the staff members working with vulnerable patient populations in psychiatric hospitals are ethically competent. Electronic supplementary material The online version of this article (10.1186/s12888-019-2200-x) contains supplementary material, which is available to authorized users.

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: the DRILL tool (Dundrum restriction, intrusion and liberty ladders)

“…While there is some evidence that uses of restrictive and coercive practices are not reducing [ 16 , 31 , 32 ], there is evidence that the systematic introduction of structured risk assessment can reduce levels of violence and aggression in psychiatric wards [ 33 , 34 ] and that the use of short term risk assessment to reduce violence does so by leading to appropriate interventions [ 35 ]. There is evidence that short term risk assessment reduces coercive practices [ 36 ] and aggression [ 37 , 38 ] along with other preventive measures [ 14 , 39 ].…”

Prevention and management of aggressive behaviour in patients at psychiatric hospitals: a document analysis of clinical practice guidelines in Hong Kong

“…2014; Välimäki et al . 2019). The major justifications for the use of physical restraint and seclusion can be to maintain patient safety and the safety of other patients and staff on the ward (Gerace & Muir‐Cochrane 2019).…”

A tool to evaluate proportionality and necessity in the use of restrictive practices in forensic mental health settings: The DRILL tool (Dundrum Restriction, Intrusion and Liberty Ladders).

“…While there is some evidence that use of restrictive and coercive practices are not reducing (10,21,22), there is evidence that the systematic introduction of structured risk assessment can reduce levels of violence and aggression in psychiatric wards (23,24) and that the use of short term risk assessment to reduce violence does so by leading to appropriate interventions (25) and evidence that short term risk assessment reduces coercive practices (26) and aggression (27,28) along with other preventive measures (8,29). The criticism that there is lack of evidence for the effectiveness of preventive practices may arise from lack of a theoretical framework, lack of a validated system for description and lack of a system for measurement so that scientific studies have not been possible.…”