Abstract
Background
Previous studies comparing restraint data from different countries had to rely on randomly published data and showed wide variance in the prevalence of restraint between countries.
Aim
To systematically compare datasets from four similar European countries with regard to restraint prevalence.
Methods
We analysed whole country or area datasets on restraint from Wales, Ireland, Germany and the Netherlands systematically, thus excluding selection, patient and setting bias. Learning disability (LD) and forensic settings were analysed separately. Differences in proportions between countries were tested by means of Chi square, with number of admissions, admission days and catchment area as denominator and counts of restraint as numerators.
Results
Full datasets were obtained allowing calculations of total admissions, total restraint numbers, numbers of patients involved and total occupied bed days. Data for Ireland is from 2012 and from 2013 for the other three countries. The percentage of patients exposed to restraint varies between 4.5 and 9.4 %. The average number of restraints per patient is stable at around 3 in all countries. Patient numbers affected by restraint per 100 occupied bed days per month vary between 0.095 and 0.200. The Netherlands have the highest use of seclusion (79 %), the longest restraint times and low use of enforced medication. Wales the lowest use of seclusion (2 %), followed by Ireland (29 %) and Germany (49 %). Events per 100 admissions per month vary between 17 and 21. Patients affected by restraint per 100 admissions per month vary between 5.4 and 7.5. LD services account for a disproportionately high number of restraint events.
Conclusion
Patient related restraint data are remarkably similar between countries. Type and length of restraint still vary significantly.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Lepping P Violence and aggression. In: Nicholls K (ed) Psychiatric emergencies. Royal College of Psychiatrists publishing. ISBN: 9781909726307
Krüger C, Mayer H, Haastert B, Meyer G (2013) Use of physical restraints in acute hospitals in Germany: a multi-centre cross-sectional study. Int J Nurs Stud 50(12):1599–606. doi:10.1016/j.ijnurstu.2013.05.005
Steinert T, Lepping P (2009) Legal provisions and practice in the management of violent patients. A case vignette study in 16 European countries. Eur Psychiatry 24(2):135–141
Kalisova L, Raboch J, Nawka A, Sampogna G, Cihal L, Kallert TW, Onchev G, Karastergiou A, Del Vecchio V, Kiejna A, Adamowski T, Torres-Gonzales F, Cervilla JA, Priebe S, Giacco D, Kjellin L, Dembinskas A, Fiorillo A (2014) Do patient and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study. Soc Psychiatry Psychiatr Epidemiol 49(10):1619–1629
LeBel JL, Duxbury JA, Putkonen A, Sprague T, Rae C, Sharpe J (2014) Multinational experiences in reducing and preventing the use of restraint and seclusion. J Psychosoc Nurs Ment Health Serv 52(11):22–29
Steinert T, Lepping P, Bernhardsgrütter R, Conca A, Hatling T, Janssen W, Keski-Valkama A, Mayoral F, Whittington R (2010) Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends. Soc Psychiatry Psychiatr Epidemiol 45(9):889–897
Steinert T, Noorthoorn EO, Mulder CL (2014) The use of coercive interventions in mental health care in Germany and the Netherlands. A comparison of the developments in two neighbouring countries. Front Public Health 2(141):1–5
Chan CC, Chung CH (2005) A retrospective study of seclusion in an emergency department. Hong Kong J Emerg Med 12(1):6–12
Noorthoorn E, Lepping P, Jansen W, Hoogendoorn A, Nijman H, Widdershoven G, Steinert T (2015) One year incidence and prevalence of coercion in the Netherlands: dutch findings in an international perspective. Soc Psychiatry Psychiatr Epidemiol 50(12):1857–1869
Wu WWK (2015) Psychosocial correlates of patients being physically restrained within the first 7 days in an acute psychiatric admission ward: retrospective case record review. East Asian Arch Psychiatry 25(2):47–57
Steinert T, Martin V, Baur M, Bohnet U, Goebel R, Hermelink G, Kronstorfer R, Kuster W, Martinez-Funk B, Roser M, Schwink A, Voigtländer W (2007) Diagnosis-related frequency of compulsory measures in 10 German psychiatric hospitals and correlates with hospital characteristics. Soc Psychiatry Psychiatr Epidemiol 42(2):140–145
Steinert T, Zinkler M, Elsässer-Gaißmaier HP, Starrach A, Hoppstock S, Flammer E (2015) Long-term tendencies in the use of seclusion and restraint in five psychiatric hospitals in Germany. Psychiatrischer Praxis 42:377–383 [Article in German]
Massod B, Lepping P, Jones E, Morris M, Lewis M, MsEwan J, Sussex P, Owen G. National data on coercion in psychiatry from Wales. Audit registered with BCULHB
Report. Mental Health crisis care: physical restraint in crisis. http://www.mind.org.uk/media/197120/physical_restraint_final_web_version.pdf. Accessed 8 Dec 2015
Bowers L, Stewart D, Papadopoulos C, Dack C, Ross J, Khanom H, Jeffrey D (2011) Inpatient violence and aggression: a literature review. Report from the Conflict and Containment Reduction Research Programme. Kings College Institute of Psychiatry, London. http://www.kcl.ac.uk/ioppn/depts/hspr/research/ciemh/mhn/projects/litreview/LitRevAgg.pdf. Accessed 8 Dec 2015
Janssen WA, van de Sande R, Noorthoorn EO, Nijman HL, Bowers L, Mulder CL, Smit A, Widdershoven GA, Steinert T (2011) Methodological issues in monitoring the use of coercive measures. Int J Law Psychiatry 34(6):429–438
https://www.nice.org.uk/guidance/ng10. Accessed 8 Jul 2015
Local Government and care partnerships directorate (2014) Positive and Proactive Care: reducing the need for restrictive interventions. Report Department of Health, London. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/300293/JRA_DoH_Guidance_on_RP_web_accessible.pdf
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/300293/JRA_DoH_Guidance_on_RP_web_accessible.pdf. Accessed 08 Jul 2015
http://www.wales.nhs.uk/sites3/Documents/816/Mental%20Health%20Act%201983%20Code%20of%20Practice%20for%20Wales.pdf. Accessed 08 Dec 2015)
(2014) The use of seclusion, mechanical means of bodily restraint and physical restraint in approved centres: activities report 2012. Mental Health Commission (Ireland). http://www.mhcirl.ie/File/The-Use-of-Seclusion-Mechanical-Restraint-and-Physical-Restraint-in-Approved-Centres-Activities-Report-2012.pdf. Accessed 08 Jul 2015
Organization for Economic Co-operation and Development. Focus on Mental Health report. https://www.oecd.org/els/health-systems/Focus-on-Health-Making-Mental-Health-Count.pdf. Accessed 8 Dec 2015
Bowers L, Alexander J, Bilgin H, Botha M, Dack C, James K, Jarrett M, Jeffery D, Nijman H, Owiti JA, Papadopoulos C, Ross J, Wright S, Stewart D (2014) Safewards: the empirical basis of the model and a critical appraisal. J Psychiatric Mental Health Nurs 21(4):354–364
Bak J, Aggernæs H (2012) Coercion within Danish psychiatry compared with 10 other European countries. Nord J Psychiatry 66(5):297–302
Vruwink FJ, Mulder CL, Noorthoorn EO, Uitdenbroek D, Nijman HLI (2012) The effects of a nationwide program to reduce seclusion in the Netherlands. BMC Psychiatry 12:231
Flammer E and Steinert T (2014) Impact of the temporaneous lack of legal basis for involuntary treatment on the frequency of aggressive incidents, seclusion and restraint among patients with chronic schizophrenic disorders. Psychiatrischer Praxis. doi:10.055/s-0034-1370069. [Article in German]
Acknowledgments
We would like to thank Prof Tilman Steinert, Prof Tom Palmstierna and Prof Raveesh BN for their helpful comments.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Lepping, P., Masood, B., Flammer, E. et al. Comparison of restraint data from four countries. Soc Psychiatry Psychiatr Epidemiol 51, 1301–1309 (2016). https://doi.org/10.1007/s00127-016-1203-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00127-016-1203-x