Use of antipsychotics and benzodiazepines in connection to minimising coercion and mechanical restraint in a general psychiatric ward

Abstract

Decrease in coercive measures from 2013 to 2016 has not lead to significant increases in the use of antipsychotic medication or benzodiazepines. The interventions are useful in establishing restraint-free wards, and careful monitoring of the psychopharmacological treatment is important for patient safety.

Preventing and reducing ‘coercion’ in mental health services: an international scoping review of English‐language studies

“…Less common study types sought the following: i)To assess the impact of rates of one type of coercion (for example, reducing physical restraint) on rates of other types of coercion (such as chemical restraint) or on rates of ‘conflict’ (4 studies) ; ii)To identify efforts that indirectly resulted in reductions in coercion (for example, testing whether unlocked wards or increased service funding reduced coercion) (3 studies) ; iii)To investigate the impact of service user organizations and their individual and systemic advocacy to prevent coercive practices and develop ‘alternative rights‐based approaches’ (2 studies) ; iv)To examine legal and practice issues related to the exercise of ‘powers’ of coercion, for example in housing or social work , again with the aim of reduction or elimination (6 studies); v)To examine problems defining and recording coercive measures, with the aim of improving data collection to inform reduction or elimination efforts (2 studies) . …”

Do improved structural surroundings reduce restrictive practices in psychiatry?

“…In line with a Danish study examining the effect of Safewards on RP [ 41 ], we found that the prescription of involuntary medication and mechanical restraint was aligned with a simultaneous decrease in both mechanical restraint and involuntary acute medication. Similarly, a Danish study found that a reduction in the use of mechanical restraint did not increase the overall use of antipsychotics and benzodiazepines [ 42 ]. Contrastingly, a nationwide Dutch study found that even though seclusion decreased significantly, “forced medication” increased; however, the pattern was not uniform as the rates varied between hospitals [ 43 ].…”