Abstract
BackgroundEvery psychiatrist must pay careful attention to avoid violating human rights when initiating coercive treatments such as seclusion and restraint. However, these interventions are indispensable in clinical psychiatry, and they are often used as strategies to treat agitated patients. In this study, we investigated young psychiatrists' attitudes toward psychiatric coercive measures.MethodsA total of 183 young psychiatrists participated as subjects in our study. A questionnaire with a case vignette describing a patient with acute psychosis was sent to the study subjects via the Internet or by mail. This questionnaire included scoring the necessity for hospitalization, and the likelihood of prescribing seclusion and/or restraint, on a 9-point Likert scale (with 9 indicating strong agreement).ResultsThere was general agreement among the study subjects that the case should be admitted to a hospital (8.91 ± 0.3) and secluded (8.43 ± 1.0). The estimated length of hospitalization was 13.53 ± 6.4 weeks. Regarding the likelihood of prescribing restraint, results showed great diversity (5.14 ± 2.5 on 9-point scale); psychiatrists working at general hospitals scored significantly higher (6.25 ± 2.5) than those working at university hospitals (5.02 ± 2.3) or psychiatric hospitals (4.15 ± 2.6). A two-group comparison of the length of inpatient care revealed a significant difference between those psychiatrists who scored 1-3 (n = 55, 14.22 ± 7.4 wks) and those who scored 7-9 (n = 62, 12.22 ± 4.0) regarding the need to use restraint.ConclusionOur results may reflect the current dilemma in Japanese psychiatry wherein psychiatrists must initiate coercive measures to shorten hospitalization stays. This study prompted its subject psychiatrists to consider coercive psychiatric treatments.
Highlights
Every psychiatrist must pay careful attention to avoid violating human rights when initiating coercive treatments such as seclusion and restraint
The Mental Health Act in Japan was initially passed on May 1, 1950, and was originally called the Mental Hygiene Law
Site investigators were recruited through the Japan Young Psychiatrists Organization's (JYPO; http:// jypo.umin.jp/) listserv, and those site investigators in turn encouraged their colleagues to participate in the survey
Summary
Every psychiatrist must pay careful attention to avoid violating human rights when initiating coercive treatments such as seclusion and restraint These interventions are indispensable in clinical psychiatry, and they are often used as strategies to treat agitated patients. Controlled studies have provided no evidence about the validity of such interventions, primarily because ethical considerations make it difficult to perform randomized controlled trials [2,3]. Such involuntary treatments are indispensable in many clinical practice scenarios, and they are commonly used as strategies to treat patients exhibiting disruptive and violent behaviors [3,4,5,6,7]. All psychiatrists practicing in Japan must abide by this law, which provides for the fundamental human rights of people with psychiatric problems
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