Prevalence and risk factors for seclusion and restraint in old-age psychiatry inpatient units

Chieze, Marie; Kaiser, Stefan; Courvoisier, Delphine S.; Hurst, Samia; Sentissi, Othman; Fredouille, Jérôme; Wullschleger, Alexandre

doi:10.1186/s12888-021-03095-4

Cited by 9 publications

(19 citation statements)

References 54 publications

(88 reference statements)

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“…The risk of abuse of power associated with paternalism is now taken seriously ( 31 , 32 ). The issue of paternalism is hotly debated in medical ethics ( 28 , 33 ), especially in psychiatry ( 27 , 34 ) and the context of coercive interventions ( 4 , 6 , 7 , 35 , 36 ). Distinctions between strong/hard vs. weak/soft paternalism and social (for the good of the community) vs. medical (for the good of the individual) paternalism have been made ( 4 , 7 , 27 , 28 , 33 , 34 ).…”

Section: Introductionmentioning

confidence: 99%

Coercive Measures in Psychiatry: A Review of Ethical Arguments

et al. 2021

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Introduction: Coercion is frequent in clinical practice, particularly in psychiatry. Since it overrides some fundamental rights of patients (notably their liberty of movement and decision-making), adequate use of coercion requires legal and ethical justifications. In this article, we map out the ethical elements used in the literature to justify or reject the use of coercive measures limiting freedom of movement (seclusion, restraint, involuntary hospitalization) and highlight some important issues.Methods: We conducted a narrative review of the literature by searching the PubMed, Embase, PsycINFO, Google Scholar and Cairn.info databases with the keywords “coercive/compulsory measures/care/treatment, coercion, seclusion, restraint, mental health, psychiatry, involuntary/compulsory hospitalization/admission, ethics, legitimacy.” We collected all ethically relevant elements used in the author's justifications for or against coercive measures limiting freedom of movement (e.g., values, rights, practical considerations, relevant feelings, expected attitudes, risks of side effects), and coded, and ordered them into categories.Results: Some reasons provided in the literature are presented as justifying an absolute prohibition on coercion; they rely on the view that some fundamental rights, such as autonomy, are non-negotiable. Most ethically relevant elements, however, can be used in a balanced weighting of reasons to favor or reject coercive measures in certain circumstances. Professionals mostly agree that coercion is only legitimate in exceptional circumstances, when the infringement of some values (e.g., freedom of movement, short-term autonomy) is the only means to fulfill other, more important values and goals (e.g., patient's safety, the long-term rebuilding of patient's identity and autonomy). The results of evaluations vary according to which moral elements are prioritized over others. Moreover, we found numerous considerations (e.g., conditions, procedural values) for how to ensure that clinicians apply fair decision-making procedures related to coercion. Based on this analysis, we highlight vital topics that need further development.Conclusion: Before using coercive measures limiting freedom of movement, clinicians should consider and weigh all ethically pertinent elements in the situation and actively search for alternatives that are more respectful of patient's well-being and rights. Coercive measures decided upon after a transparent, carefully balanced evaluation process are more likely to be adequate, understood, and accepted by patients and caregivers.

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Section: Introductionmentioning

confidence: 99%

Coercive Measures in Psychiatry: A Review of Ethical Arguments

et al. 2021

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“…Previous studies also did not identify the associations between the score of SACS and the actual use of coercive measures ( 36 , 37 ). Actual use of seclusion/restraints is known to be highly affected by patients’ characteristics, including symptoms, diagnosis, mental health problems, admission status, age, and sex ( 36 , 38 – 45 ), as well as organizational factors such as the location of the institution, composition of staff, ward size, and ward design ( 36 , 39 , 44 , 46 , 47 ). These factors were not adjusted for in our study, which could be a reason for the null-association between the staff’s attitudes and the use of seclusion/restraints in our study.…”

Section: Discussionmentioning

confidence: 99%

“…It was possible that 3 months was too short that the use of seclusion/restraints in a ward was heavily affected by the occasional characteristics of inpatients during the period, which might obscure the influence of the staff 's attitudes toward coercion. Third, when exploring the associations between the SACS score and the actual use of seclusion/restraints in a ward, we could not adjust for the patients' characteristics such as diagnosis and clinical symptoms, which might affect the use of seclusion/restraints (36,(38)(39)(40)(41)(42)(43)(44)(45). Fourth, we conducted our study in urban areas.…”

Section: Limitationsmentioning

confidence: 99%

Development of the Japanese version of Staff Attitude to Coercion Scale

et al. 2022

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BackgroundAn important factor in proceeding the efforts to reduce coercion in psychiatry is the attitudes of clinical staff toward its use. We aimed to develop the Japanese version of the Staff Attitude to Coercion Scale (SACS) and clarify its psychometric properties.MethodsAfter the translation and back-translation of the SACS, which includes 15 items consisting of three subscales, we conducted an anonymous self-administered questionnaire survey of clinical staffs working in 17 wards in two psychiatric hospitals. We administered the second survey to some of the participants to confirm the test-retest reliability. Additionally, we obtained information regarding the 17 wards from the institutions. Internal consistency was assessed using Cronbach’s alpha coefficients. Test-retest reliability was assessed using intraclass correlation coefficients (ICC). Structural validity was examined using confirmatory factor analysis (CFA) and exploratory factor analysis (EFA). For construct validity, the correlation of the SACS score within wards and its association with the actual use of seclusion/restraints were explored using multilevel multivariate linear regression analyses.ResultsWe used 261 (67.1%) responses, 35 responses of which were also used to examine test-retest reliability. Cronbach’s alpha coefficients (0.761) and ICC (0.738) indicated good reliability. The results of CFA based on the original three-dimensional structure did not indicate a good fit (CFA = 0.830, RMSEA = 0.088). EFA suggested a four-factor structure, two of which were almost consistent with the original two subscales. The correlation of the SACS score within wards was confirmed while a positive association with the actual use of seclusion/restraints was not identified.ConclusionWhile the original three-dimensional structure was not replicated, construct validity was partially confirmed. Reliability of the total scale was good. In Japan, although using the subscales was not recommended, using the total scale of SACS seemed acceptable.

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“…Of note, prescribed medications were not considered in our study. Another study examined use of seclusion and restraint in the geriatric psychiatry division of Geneva University Hospital 39. In this setting, risk factors for seclusion and restraint were younger age, male sex, being divorced or married, cognitive disorders, previous psychiatric hospitalizations and involuntary referrals from the emergency department.…”

Section: Discussionmentioning

confidence: 99%

Seclusion, Restraint, Therapeutic Alliance, and Legal Admission Status: What Really Matters?

O’Callaghan

Plunkett

Kelly

2022

Journal of Psychiatric Practice

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Objective: To determine the relationships, if any, between use of seclusion and restraint and factors such as demographic parameters, diagnosis, legal admission status (voluntary or involuntary), symptoms, cognitive function, global functioning, therapeutic alliance, attitudes toward medication, and insight, among psychiatry inpatients in Ireland. Methods: We used validated tools to perform detailed assessments of 107 adult psychiatry inpatients admitted to acute psychiatry units at 2 general hospitals in Dublin, Ireland over a 30-month period, between September 2017 and February 2020. Results: The most common diagnoses in our sample were affective disorders (46.7%), schizophrenia and related disorders (27.1%), and personality and behavioral disorders (11.2%). Over a quarter (n = 29, 27.1%) of the participating patients had involuntary legal status. Of the 107 patients, 11 patients (10.3%) experienced sedation and/or physical restraint, with 9 patients (8.4%) experiencing at least 1 episode of seclusion and 10 patients (9.3%) experiencing at least 1 episode of physical restraint. On the basis of multivariable analyses, seclusion was associated with younger age and involuntary status, while physical restraint was associated with involuntary status. Each multivariable model explained just over one third of the variance in the distribution of these seclusion and restraint practices. Conclusions: Use of seclusion and restraint was most strongly associated with involuntary admission status and, in the case of seclusion, younger age, rather than sex, diagnosis, symptoms, cognitive function, global functioning, therapeutic alliance, attitudes toward medication, or insight. The network of interactions between involuntary status and use of seclusion and restraint merits much closer attention, especially as use of seclusion and physical restraint appears to be associated with involuntary legal status independent of level of symptoms, therapeutic alliance, or insight.

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Prevalence and risk factors for seclusion and restraint in old-age psychiatry inpatient units

Cited by 9 publications

References 54 publications

Coercive Measures in Psychiatry: A Review of Ethical Arguments

Coercive Measures in Psychiatry: A Review of Ethical Arguments

Development of the Japanese version of Staff Attitude to Coercion Scale

Seclusion, Restraint, Therapeutic Alliance, and Legal Admission Status: What Really Matters?

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