Restraint Of Psychiatric Patients Research Articles

Effects of the Decision of the German Constitutional Court on mechanical restraint in 2018 : Coercive measures in the psychiatric hospitals in Baden-Wuerttemberg in 2019 compared to the years 2015-2017

On 23July 2018 the German Constitutional Court decided that mechanical restraint in psychiatric patients with 5or 7‑point mechanical restraint lasting longer than 30 min requires ajudicial authorization. On the same day, the German Association for Psychiatry and Psychotherapy (DGPPN) published guidelines on the prevention of coercion and violence. Together, this can be considered as the strongest intervention to reduce coercion on anational level worldwide. The registry for coercive measures in the Federal State of Baden-Wuerttemberg, available since 2015 and comprising all 32hospitals licensed to admit involuntary patients, has made it possible to evaluate the effect of the legal change. We analyzed 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 2015 to 2017 compared to 2019 among atotal of 438,003 admissions. The percentage of patients subjected to any kind of freedom-restricting coercion (restraint or seclusion) decreased from 6.7% (average 2015-2017) to 5.8% in 2019 (p < 0.001). Effects were strongest in patients with organic (F0) and schizophrenic disorders (F2). The percentage of patients subjected to mechanical restraint decreased from 4.8% to 3.6% in 2019, and the percentage of mechanical restraints less than 30 min increased from 1.8% to 10.5%. Vice versa, the percentage of patients subjected to seclusion increased from 2.9% to 3.3%. The median cumulated duration of restraint and seclusion per affected case decreased from12.7h to10.9 h (median). The intervention was probably responsible for areduction of the percentage of cases subjected to coercive measures by about 13% and areduction of the duration of these measures per affected case by about 14%.

Effect of the introduction of immediate judge's decisions in 2018 on the use of coercive measures in psychiatric hospitals in Germany: a population-based study.

BackgroundOn 23 July 2018, the German Constitutional Court decided that mechanical restraint in psychiatric patients lasting longer than 30 minutes requires a judge's immediate decision. On the same day, the German Association for Psychiatry and Psychotherapy published its guideline on the prevention of coercion and violence. The registry for coercive measures in the federal state of Baden-Wuerttemberg, available since 2015 and comprising all 32 hospitals licensed to admit involuntary patients, has made it possible to evaluate the effect of the legal change, considered the strongest intervention ever in Germany to reduce coercion.MethodsWe 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 2017 compared to 2019 among a total of 233,0273 admissions.FindingsThe percentage of patients subjected to any kind of freedom-restricting coercion decreased from 6·6% in 2017 to 5·8% in 2019 (p = 0·000). Accordingly, the percentage of patients subjected to mechanical restraint decreased from 4·8% to 3·6% in 2019 (p = 0·000). At the same time, the percentage of patients subjected to seclusion increased from 2·9% to 3·3% (p = 0·000). The median cumulated duration of restraint and seclusion per affected case decreased from 12·5 to 11·9 hrs (p = 0·001).InterpretationThere is clear evidence that a strong legal intervention was effective in reducing the use of coercive measures under routine conditions.FundingThe registry is funded by the Ministry of Social Welfare and Integration.

Effect of the Introduction of Mandatory Court Decisions in 2018 on the Use of Coercive Measures in Psychiatric Hospitals in Germany

Background: On 23 July 2018, the German Constitutional Court decided that mechanical restraint in psychiatric patients lasting longer than 30 minutes requires a judge’s immediate decision. On the same day, the German Association for Psychiatry and Psychotherapy published its guideline on the prevention of coercion and violence. The registry for coercive measures in the federal state of Baden-Wuerttemberg, available since 2015 and comprising all 32 hospitals licensed to admit involuntary patients, has made it possible to evaluate the effect of the legal change, considered the strongest intervention ever in Germany to reduce coercion. Method: 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 2015 to 2017 compared to 2019 among a total of 438,003 admissions. Results: The percentage of patients subjected to any kind of freedom-restricting coercion decreased from 6·7% (averaged 2015–2017) to 5·8% in 2019 (p < 0·001). Accordingly, the percentage of patients subjected to mechanical restraint decreased from 4·8% to 3·6% in 2019. At the same time, the percentage of patients subjected to seclusion increased from 2·9% to 3·3%. The median cumulated duration of restraint and seclusion per affected case decreased from 11·4 to 10·0 hrs (p < 0·001). The greatest effects were found in patients with organic disorders and schizophrenic disorders. Conclusion: There is clear evidence that a strong legal intervention was effective in reducing the use of coercive measures under routine conditions. Funding: The registry is funded by the Ministry of Social Welfare and Integration. Declaration of Interest: None to declare. Ethical Approval: The Ethics Committee of Ulm University waived the requirement for ethics approval as approval is not required for studies analysing anonymised data, in accordance with national legislation and institutional requirements.

Psychological adjustment in care providers following restraint of psychiatric patients.

Mental healthcare providers face many difficult interactions with patients that can be emotionally demanding and have adverse effects on their well-being. Recent theoretical models suggest that the interpretation of stressful episodes may be more important for psychological adjustment than the nature of the episodes. This study examined whether care providers' interpretations of mechanical restraint episodes were related to their adjustment. We asked 80 mental healthcare providers to recall mechanical restraint episodes and to rate them on centrality to identity and positive and negative influence on self-understanding. They also completed scales measuring current symptoms of post-traumatic stress, depression, life satisfaction, and well-being. The results showed that care providers who interpreted mechanical restraint episodes as having a central negative influence on their identity experienced more symptoms of post-traumatic stress. Care providers who gave higher ratings of positive self-change following episodes reported more well-being. Our findings suggest, that considering care providers' subjective interpretations of episodes and not merely the objective facts surrounding them is critical if we wish to mitigate the negative emotional impact of episodes.

Protocol for the management of psychiatric patients with psychomotor agitation

BackgroundPsychomotor agitation (PMA) is a state of motor restlessness and mental tension that requires prompt recognition, appropriate assessment and management to minimize anxiety for the patient and reduce the risk for escalation to aggression and violence. Standardized and applicable protocols and algorithms can assist healthcare providers to identify patients at risk of PMA, achieve timely diagnosis and implement minimally invasive management strategies to ensure patient and staff safety and resolution of the episode.MethodsSpanish experts in PMA from different disciplines (psychiatrists, psychologists and nurses) convened in Barcelona for a meeting in April 2016. Based on recently issued international consensus guidelines on the standard of care for psychiatric patients with PMA, the meeting provided the opportunity to address the complexities in the assessment and management of PMA from different perspectives. The attendees worked towards producing a consensus for a unified approach to PMA according to the local standards of care and current local legislations. The draft protocol developed was reviewed and ratified by all members of the panel prior to its presentation to the Catalan Society of Psychiatry and Mental Health, the Spanish Society of Biological Psychiatry (SEPB) and the Spanish Network Centre for Research in Mental Health (CIBERSAM) for input. The final protocol and algorithms were then submitted to these organizations for endorsement.ResultsThe protocol presented here provides guidance on the appropriate selection and use of pharmacological agents (inhaled/oral/IM), seclusion, and physical restraint for psychiatric patients suspected of or presenting with PMA. The protocol is applicable within the Spanish healthcare system. Implementation of the protocol and the constituent algorithms described here should ensure the best standard of care of patients at risk of PMA. Episodes of PMA could be identified earlier in their clinical course and patients could be managed in the least invasive and coercive manner, ensuring their own safety and that of others around them.ConclusionEstablishing specialized teams in agitation and providing them with continued training on the identification of agitation, patient management and therapeutic alternatives might reduce the burden of PMA for both the patient and the healthcare system.

Physical Restraint: A Historical Review and Current Practice

The use of physical restraint in the management of psychiatric patients has a history dating back at least 300 years, with its origins in society finding a quid pro quo legal justification for taking action against unruly citizens. It became increasingly obvious through the years that such practices were violations of patients' civil rights. The consumer movement in mental health in the 1960s and patients' rights cases involving the 14th amendment to the US Constitution that soon followed changed the views and policies related to the use of physical restraint in psychiatric patients. This article discusses current practices and strategies to minimize the use of physical restraint. [ Psychiatr Ann . 2017;47(1):52–55.]

Patients and Nurses' Opinion about uses of physical restraint for psychiatric patients in Mental Health Hospital

Physical restraint is any manual method or mechanical device attached to the patient's body that restricts freedom of movement and cannot be easily removed. Despite extensive literature on the potential complications of using physical restraint, it is still considered as a permanent and effective intervention in the management of unpleasant behaviors. This study aimed to assess patients' and nurses' opinion about uses of physical restraint on psychiatric patients in Mental Health Hospital. Study was conducted in Tanta Mental Health Hospital which is affiliated to Ministry of Health. The study subjects include 49 psychiatric patient and all nurses working in Tanta Mental Health Hospital (80 nurses). Two tools were developed by the researcher to collect the necessary data. Tool (1) was Patient Structured Interview questionnaire, and Tool (2) was nurses structured Interview questionnaire. The main results revealed that a round one third of studied patients had negative opinions about use of physical restraint, and nearly half of them were average. In another hand more than half of studied nurses had positive opinion and nearly to one third were average regarding to using of physical restraints, so it was recommended that nurses should be involved in educational program about; therapeutic use of self and effective communication skills to improve their interaction with patient and encourage them to express gradually about their strong feeling, and educated about aggressive behaviors, it's dynamic and predisposing factors, and how applied physical restraints effectively with patients and debriefing following these procedure to minimize a negative effects on patients.

Patients and Nurses' Opinion about uses of physical restraint for psychiatric patients in Mental Health Hospital

Patients and Nurses' Opinion about uses of physical restraint for psychiatric patients in Mental Health Hospital

Perception During and After Physical Restraint in Psychiatric Patients

Background Although discussed controversially, coercive practices during involuntary admission are common in mental health services. The impact of physical restraints on patients has not been sufficiently studied. Aims To investigate the subjective perception of patients during and after physical restraint. Method 47 patients in a psychiatric intermediate care facility experiencing belt fixation were interviewed and filled out self-assessment forms at 4 visits. Results The median duration of restraint was 99 hours. Median VAS scores indicated moderate levels of anxiety. With increasing time span from the fixation, memory regarding this event decreased and patients experienced a regain of self-control. Consistently, 50% perceived high levels of coercion at admission, PTSD could be supposed in 25% of the patients. Conclusion Despite a considerable restraint of freedom, distress related to belt-fixation seems acceptable in our sample. Patients’ disapproval concerning restraint measures seems to diminish with time, probably related to decreasing memory regarding the fixation practice.

Role of substance abuse in requirement of physical restraint of psychiatric patients in emergency setting

Background The practice of physical restraint in psychiatric emergency practice is rather frequent. Patients with substance abuse more often present aggressive behavior requiring physical restraint in such settings. The legal frame for such practice in our country is defined in the Law for the protection of persons with mental disturbances. Patients admitted to a psychiatric emergency ward were analyzed prospectively according to their need of physical restraint.

An attributional study of seclusion and restraint of psychiatric patients

This descriptive study used two attributional frameworks to examine the causes psychiatric inpatients and nurses gave for the seclusion and restraint of patients. Patients were interviewed in restraints. The reasons patients and nurses gave for the patients restraint were recorded verbatim. A nominal system using the recorded responses was developed by two attribution researchers and were also coded along the dimensions of locus, controllability, and stability. The findings supported attribution theory and research in that most patients and nurses gave causes for the patients' restraint. However, the data suggest more research is needed in this area.