Do patient and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study

PurposeThis study aims to identify whether selected patient and ward-related factors are associated with the use of coercive measures. Data were collected as part of the EUNOMIA international collaborative study on the use of coercive measures in ten European countries.MethodsInvoluntarily admitted patients (N = 2,027) were divided into two groups. The first group (N = 770) included patients that had been subject to at least one of these coercive measures during hospitalization: restraint, and/or seclusion, and/or forced medication; the other group (N = 1,257) included patients who had not received any coercive measure during hospitalization. To identify predictors of use of coercive measures, both patients’ sociodemographic and clinical characteristics and centre-related characteristics were tested in a multivariate logistic regression model, controlled for countries’ effect.ResultsThe frequency of the use of coercive measures varied significantly across countries, being higher in Poland, Italy and Greece. Patients who received coercive measures were more frequently male and with a diagnosis of psychotic disorder (F20–F29). According to the regression model, patients with higher levels of psychotic and hostility symptoms, and of perceived coercion had a higher risk to be coerced at admission. Controlling for countries’ effect, the risk of being coerced was higher in Poland. Patients’ sociodemographic characteristics and ward-related factors were not identifying as possible predictors because they did not enter the model.ConclusionsThe use of coercive measures varied significantly in the participating countries. Clinical factors, such as high levels of psychotic symptoms and high levels of perceived coercion at admission were associated with the use of coercive measures, when controlling for countries’ effect. These factors should be taken into consideration by programs aimed at reducing the use of coercive measures in psychiatric wards.

[1]  A. Finset,et al.  A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics , 2010, BMC health services research.

[2]  J. Talbott.  Coercion in Psychiatric Care: Systematic Review of Correlates and Themes , 2013 .

[3]  J. Borckardt,et al.  Systematic investigation of initiatives to reduce seclusion and restraint in a state psychiatric hospital. , 2011, Psychiatric services.

[4]  S. Hoge,et al.  Prospective study of patients' refusal of antipsychotic medication under a physician discretion review procedure. , 1997, The American journal of psychiatry.

[5]  M. Maj,et al.  Patient characteristics and symptoms associated with perceived coercion during hospital treatment , 2012, Acta psychiatrica Scandinavica.

[6]  Julia S. Brown,et al.  On the seclusion of psychiatric patients. , 1992, Social science & medicine.

[7]  S. Banks,et al.  Predictors of the use of restraint and seclusion in public psychiatric hospitals , 1996, Administration and Policy in Mental Health and Mental Health Services Research.

[8]  Rose McCabe.  Talking about adherence , 2013, World psychiatry : official journal of the World Psychiatric Association.

[9]  S. Bremner,et al.  Coerced Hospital Admission and Symptom Change—A Prospective Observational Multi-Centre Study , 2011, PloS one.

[10]  E. Dusseldorp,et al.  use of seclusion Impact of the physical environment of psychiatric wards on the , 2013 .

[11]  J. Rymaszewska,et al.  Differences of legal regulations concerning involuntary psychiatric hospitalization in twelve European countries: implications for clinical practice , 2007, BMC Psychiatry.

[12]  B. Huitfeldt,et al.  The relationship fo crowding and aggressive behaviour on a psychiatry intensive care unit , 1991 .

[13]  A. Fiorillo,et al.  Use of coercive measures in mental health practice and its impact on outcome: a critical review , 2014, Expert review of neurotherapeutics.

[14]  T. Steinert,et al.  The use of mechanical restraint and seclusion in patients with schizophrenia: A comparison of the practice in Germany and Switzerland , 2007, Clinical practice and epidemiology in mental health : CP & EMH.

[15]  S. Priebe,et al.  Acute psychopathology as a predictor of global functioning in patients with ICD-10 non-affective psychosis: A prospective study in 11 European countries , 2011, Schizophrenia Research.

[16]  B. Huitfeldt,et al.  The relationship of crowding and aggressive behavior on a psychiatric intensive care unit. , 1991, Hospital & community psychiatry.

[17]  S. Priebe,et al.  Detention of the mentally ill in Europe – a review , 2002, Acta psychiatrica Scandinavica.

[18]  T. Mason.  An ethnomethodological analysis of the use of seclusion. , 1997, Journal of advanced nursing.

[19]  Ian Hall.  Legislation on Coercive Mental Health Care in Europe: Legal Documents and Comparative Assessment of Twelve European Countries , 2008, British Journal of Psychiatry.

[20]  P. Lepping,et al.  Compulsory admission and treatment in schizophrenia: a study of ethical attitudes in four European countries. , 2005, Social psychiatry and psychiatric epidemiology.

[21]  M. Engberg,et al.  Paternalism and autonomy: a presentation of a Nordic study on the use of coercion in the mental health care system. , 2002, International journal of law and psychiatry.

[22]  W. Rössler,et al.  Variation in use of coercive measures in psychiatric hospitals , 2011, European Psychiatry.

[23]  V. Lehtinen,et al.  Predicting use of coercive measures in Finland , 2002, Nordic journal of psychiatry.

[24]  M. Holi,et al.  Seclusion and restraint in psychiatry: patients' experiences and practical suggestions on how to improve practices and use alternatives. , 2012, Perspectives in psychiatric care.

[25]  L. Shortridge‐Baggett,et al.  The use of seclusion in psychiatry: a literature review. , 1997, Scholarly inquiry for nursing practice.

[26]  O. Andreassen,et al.  Beliefs about medications: measurement and relationship to adherence in patients with severe mental disorders , 2009, Acta psychiatrica Scandinavica.

[27]  A. Riecher-Rössler,et al.  Compulsory admission of psychiatric patients – an international comparison , 1993, Acta psychiatrica Scandinavica.

[28]  Duolao Wang,et al.  Patients' views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries , 2010, British Journal of Psychiatry.

[29]  Stefan Priebe,et al.  The EUNOMIA project on coercion in psychiatry: study design and preliminary data. , 2005, World psychiatry : official journal of the World Psychiatric Association.

[30]  T. Gutheil,et al.  Seclusion and restraint in 1985: a review and update. , 1985, Hospital & community psychiatry.

[31]  V. Lehtinen,et al.  Coercion and restrictions in psychiatric inpatient treatment. , 2000, European psychiatry : the journal of the Association of European Psychiatrists.

[32]  L. Mion,et al.  Likelihood of Ordering Physical Restraints: Influence of Physician Characteristics , 2010, Journal of the American Geriatrics Society.

[33]  T. Kallert.  Coercion in psychiatry , 2008, Current opinion in psychiatry.

[34]  K. Jain,et al.  Will neurogenomics revolutionize neurotherapeutics? , 2001, Expert review of neurotherapeutics.

[35]  J. Overall,et al.  The Brief Psychiatric Rating Scale , 1962 .

[36]  R. Liberman,et al.  Brief Psychiatric Rating Scale (BPRS) Expanded Version (4.0): Scales, Anchor Points, and Administration Manual , 1993 .

[37]  J. Scanlan.  Interventions To Reduce the Use of Seclusion and Restraint in Inpatient Psychiatric Settings: What We Know So Far a Review of the Literature , 2010, The International journal of social psychiatry.

[38]  B. Goldman.  Dr. Goldman replies. , 1984 .

[39]  A. David.  Managing non‐adherence and the 3 Cs: collaboration, cash and coercion , 2013, World psychiatry : official journal of the World Psychiatric Association.

[40]  M. Reck.  Implications for Clinical Practice , 2012 .

[41]  J. Cook,et al.  A program to reduce use of physical restraint in psychiatric inpatient facilities. , 2004, Psychiatric services.

[42]  E. Noorthoorn,et al.  The influence of staffing levels on the use of seclusion. , 2007, International journal of law and psychiatry.

[43]  H. Conte,et al.  TOWARD A RATIONALE FOR THE SECLUSION PROCESS , 1978, The Journal of nervous and mental disease.

[44]  M. Raja,et al.  Hostility and violence of acute psychiatric inpatients , 2005, Clinical practice and epidemiology in mental health : CP & EMH.

[45]  L. Kjellin,et al.  Accumulated coercion and short-term outcome of inpatient psychiatric care , 2010, BMC psychiatry.

[46]  T. Mason.  Gender Differences in the Use of Seclusion , 1998, Medicine, science, and the law.

[47]  M. Engberg,et al.  Differences in perceived coercion at admission to psychiatric hospitals in the Nordic countries , 2006, Social Psychiatry and Psychiatric Epidemiology.

[48]  W. Fisher.  Restraint and seclusion: a review of the literature. , 1994, The American journal of psychiatry.

[49]  L. Kjellin,et al.  Coercion in psychiatric care – patients’ and relatives’ experiences from four swedish psychiatric services , 2004, Nordic journal of psychiatry.

[50]  J. O. Johannessen,et al.  A 2‐year follow‐up of involuntary admission’s influence upon adherence and outcome in first‐episode psychosis , 2010, Acta psychiatrica Scandinavica.

[51]  L. Bowers,et al.  Manual restraint and shows of force: the City-128 study. , 2012, International journal of mental health nursing.

[52]  E. Somoza,et al.  Hospital characteristics, diagnoses, and staff reasons associated with use of seclusion and restraint. , 1993, Hospital & community psychiatry.

[53]  R. Binder.  The use of seclusion on an inpatient crisis intervention unit. , 1979, Hospital & community psychiatry.

[54]  F. Mayoral,et al.  How to improve clinical practice on involuntary hospital admissions of psychiatric patients: Suggestions from the EUNOMIA study , 2011, European Psychiatry.

[55]  K. Hammill.  Seclusion: inside looking out. , 1987, Nursing times.

[56]  G. Mellsop,et al.  A Study of the Use of Seclusion in an Acute Psychiatric Service , 2001, The Australian and New Zealand journal of psychiatry.

[57]  S. Banks,et al.  Use of seclusion and restraint in public psychiatric hospitals: patient characteristics and facility effects. , 1990, Hospital & community psychiatry.

[58]  W. Greenberg,et al.  Patients' attitudes toward having been forcibly medicated. , 1996, The Bulletin of the American Academy of Psychiatry and the Law.

[59]  I. Georgieva,et al.  Early detection of risk factors for seclusion and restraint: a prospective study , 2012, Early intervention in psychiatry.

[60]  R. Wynn.  Coercion in psychiatric care: clinical, legal, and ethical controversies , 2006, International journal of psychiatry in clinical practice.

[61]  T. Brugha,et al.  The lifetime and past-year prevalence of dual diagnosis in people with schizophrenia across Europe: findings from the European Schizophrenia Cohort (EuroSC) , 2012, European Archives of Psychiatry and Clinical Neuroscience.

[62]  David McDaid,et al.  Actions to alleviate the mental health impact of the economic crisis , 2012, World psychiatry : official journal of the World Psychiatric Association.

[63]  J. Lönnqvist,et al.  Who are the restrained and secluded patients: a 15-year nationwide study , 2010, Social Psychiatry and Psychiatric Epidemiology.

[64]  P. Morrison,et al.  Staffing levels and seclusion use. , 2006, Journal of advanced nursing.

[65]  A. Lowenfels.  A REVIEW AND UPDATE , 1979 .

[66]  E. Salib,et al.  Practice of Seclusion: A Five-Year Retrospective Review in North Cheshire , 1998, Medicine, science, and the law.

[67]  H. Goldman,et al.  Revising axis V for DSM-IV: a review of measures of social functioning. , 1992, The American journal of psychiatry.

[68]  J. Wanderling,et al.  Variations in seclusion and restraint practices by hospital location. , 1988, Hospital & community psychiatry.

[69]  G. Thornicroft,et al.  The Mental Health Consequences of the Recession: Economic Hardship and Employment of People with Mental Health Problems in 27 European Countries , 2013, PloS one.

[70]  F. Mayoral,et al.  Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends , 2010, Social Psychiatry and Psychiatric Epidemiology.

[71]  G. Browne,et al.  The impact of seclusion on the treatment outcomes of psychotic in-patients. , 1999, Journal of advanced nursing.

[72]  A. Lesage,et al.  Staff perceptions and organizational factors as predictors of seclusion and restraint on psychiatric wards. , 2011, Psychiatric services.

[73]  T. Wykes,et al.  Psychiatric patients’ views on why their involuntary hospitalisation was right or wrong: a qualitative study , 2012, Social Psychiatry and Psychiatric Epidemiology.

[74]  D. Donat.  Encouraging alternatives to seclusion, restraint, and reliance on PRN drugs in a public psychiatric hospital. , 2005, Psychiatric services.

[75]  Robert H. Davis,et al.  Pennsylvania State Hospital system's seclusion and restraint reduction program. , 2005, Psychiatric services.

[76]  K. Tardiff.  Emergency Control Measures for Psychiatric Inpatients , 1981, The Journal of nervous and mental disease.

[77]  M. Hunter,et al.  Nursing staff's attitudes toward seclusion & restraint. , 2001, Journal of psychosocial nursing and mental health services.

[78]  A. Spengler.  Factors influencing assignment of patients to compulsory admission , 2004, Social psychiatry.

[79]  C. Swett.  Inpatient seclusion: description and causes. , 1994, The Bulletin of the American Academy of Psychiatry and the Law.

[80]  S. Johnson,et al.  The European Service Mapping Schedule (ESMS): development of an instrumentfor the description and classificationof mental health services , 2000, Acta psychiatrica Scandinavica. Supplementum.

[81]  Stefan Priebe,et al.  Use of coercive measures during involuntary hospitalization: findings from ten European countries. , 2010, Psychiatric services.

[82]  D. Misdrahi,et al.  Factors influencing compulsory admission in first-admitted subjects with psychosis , 2004, Social Psychiatry and Psychiatric Epidemiology.

[83]  S. Rabe-Hesketh,et al.  Management of psychiatric in-patient violence: patient ethnicity and use of medication, restraint and seclusion , 2004, British Journal of Psychiatry.

[84]  V. Klinge.  Staff opinions about seclusion and restraint at a state forensic hospital. , 1994, Hospital & community psychiatry.

[85]  J. Bak,et al.  Coercion within Danish psychiatry compared with 10 other European countries , 2012, Nordic journal of psychiatry.

[86]  T. Steinert,et al.  Diagnosis-related frequency of compulsory measures in 10 German psychiatric hospitals and correlates with hospital characteristics , 2007, Social Psychiatry and Psychiatric Epidemiology.

[87]  J. Lönnqvist,et al.  A 15-year national follow-up: legislation is not enough to reduce the use of seclusion and restraint , 2007, Social Psychiatry and Psychiatric Epidemiology.

[88]  G. Thornicroft,et al.  Perceived coercion at admission to psychiatric hospital and engagement with follow-up , 2005, Social Psychiatry and Psychiatric Epidemiology.

[89]  I. Georgieva,et al.  Patients’ Preference and Experiences of Forced Medication and Seclusion , 2011, Psychiatric Quarterly.