Social Psychiatry and Psychiatric Epidemiology

, Volume 42, Issue 9, pp 747-752

First online:

A 15-year national follow-up: legislation is not enough to reduce the use of seclusion and restraint

  • Alice Keski-ValkamaAffiliated withVanha Vaasa Hospital Email author 
  • , Eila SailasAffiliated withNational Research Centre for Welfare and HealthKellokoski Hospital
  • , Markku EronenAffiliated withVanha Vaasa Hospital
  • , Anna-Maija KoivistoAffiliated withTampere School of Public Health, University of TampereTampere University Hospital, Research Unit
  • , Jouko LönnqvistAffiliated withDept. of Mental Health and Alcohol Research, National Public Health InstituteDept. of Psychiatry, University of Helsinki
  • , Riittakerttu Kaltiala-HeinoAffiliated withTampere School of Public Health, University of TamperePsychiatric Treatment and Research Unit for Adolescent Intensive Care (EVA), Tampere University Hospital

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Seclusion and restraint are frequent but controversial coercive measures used in psychiatric treatment. Legislative efforts have started to emerge to control the use of these measures in many countries. In the present study, the nationwide trends in the use of seclusion and restraint were investigated in Finland over a 15-year span which was characterised by legislative changes aiming to clarify and restrict the use of these measures.


The data were collected during a predetermined week in 1990, 1991, 1994, 1998 and 2004, using a structured postal survey of Finnish psychiatric hospitals. The numbers of inpatients during the study weeks were obtained from the National Hospital Discharge Register.


The total number of the secluded and restrained patients declined as did the number of all inpatients during the study weeks, but the risk of being secluded or restrained remained the same over time when compared to the first study year. The duration of the restraint incidents did not change, but the duration of seclusion increased. A regional variation was found in the use of coercive measures.


Legislative changes solely cannot reduce the use of seclusion and restraint or change the prevailing treatment cultures connected with these measures. The use of seclusion and restraint should be vigilantly monitored and ethical questions should be under continuous scrutiny.

Key words

seclusion restraint coercion legislation