Abstract
BackgroundCoercive 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.MethodsIn 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.ResultsBetween 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.ConclusionsDespite 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.
Highlights
Coercive measures is a topic that has long been discussed in the field of psychiatry
We investigated the trends in the change of prevalence rates, looking at the difference between gender and geographic areas, and variations across psychiatric care providers
This design gave us a concise data structure where patient units were nested within psychiatric care providers, allowing one patient to represent repeated units over 20 calendar years, allowing us to estimate the variation in the prevalence of coercive measures toward patients among care providers by region, and making it possible to observe changing trends over time
Summary
Coercive measures is a topic that has long been discussed in the field of psychiatry. 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. The deinstitutionalisation of psychiatric services has led to an increase in international discussion [1,2,3] about human rights and coercive practices in psychiatric hospitals. Other factors related to the treatment environment were found in a study by Pettit et al [27] Based on their findings, the authors concluded that the availability of a seclusion room may be related to the use of seclusion, as staff members are more likely to consider seclusion as an acceptable method of managing aggressive incidents when there is a designated space for it
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