Angelika Vandamme (Charité WG Social Psychiatry and Care Research) Celline Cole (Charité WG Social Psychiatry and Care Research

Abstract

Seclusion and restraint are practices which are frequently used in inpatient psychiatric treatment and have well documented negative consequences for affected patients. They can also be seen as indicators of health care quality and mental health stigma in society. Yet, they are seldomly studied empirically. The aim of this study was to contribute to the prevention of coercive measures and respective interventions with data on the use of seclusion and restraint in a large acute psychiatric sample (N=1556) from Germany. For this purpose, patient-level clinical, sociodemographic, and admission-related predictors of seclusion and restraint were collected from medical records and analysed in order to identify the patient groups most at risk. Consistent with the hypotheses, involuntary admission to the hospital, indication of an acute manic or psychotic episode, and physical or verbal aggression against persons or objects were significant predictors for seclusion or restraint during inpatient treatment. Further, younger patient age, acute intoxication at time of admission, and limited or no communication ability in German were significantly associated with the use of coercive measures. On the other hand, contrary to hypotheses, male gender, whether a patient was known to the wards at time of admission, and interactions between diagnoses and aggression or intoxication were not significantly associated with a higher risk for restraint or seclusion. These results both support and broaden existing findings on predictors from international literature. They indicate that coercion is not applied at random but instead affects certain vulnerable groups, which should be protected better with the help of clinical psychologists. Clinical and policy-relevant recommendations as well as implications of the findings for future comprehensive research are discussed.