Social Psychiatry and Psychiatric Epidemiology

, Volume 42, Issue 9, pp 747–752

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

  • Alice Keski-Valkama
  • Eila Sailas
  • Markku Eronen
  • Anna-Maija Koivisto
  • Jouko Lönnqvist
  • Riittakerttu Kaltiala-Heino
ORIGINAL PAPER

Abstract

Background

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.

Method

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.

Results

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.

Conclusion

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 

References

  1. 1.
    Act on the Status and Rights of patients (2004) So 422. In: Suomen Laki II [Finnish Law II]. Talentum Media Oy, Helsinki, pp 1621–1624Google Scholar
  2. 2.
    Angold A (1989) Seclusion. Br J Psychiatry 154:437–444PubMedCrossRefGoogle Scholar
  3. 3.
    Betemps EJ, Somoza E, Buncher CR (1993) Hospital characteristics, diagnoses, and staff reasons associated with use of seclusion and restraint. Hosp Community Psychiatry 44:367–371PubMedGoogle Scholar
  4. 4.
    Brown JS, Tooke SK (1992) On the seclusion of psychiatric patients. Soc Sci Med 35:711–721PubMedCrossRefGoogle Scholar
  5. 5.
    Council of Europe (1994) Recommendation 1235 on psychiatry and human rights. Council of Europe, StrasbourgGoogle Scholar
  6. 6.
    Council of Europe (2004) Recommendation Rec(2004)10 of the committee of ministers to member states concerning the protection of the human rights and dignity of persons with mental disorder and its explanatory memorandum. Council of Europe, StrasbourgGoogle Scholar
  7. 7.
    Crenshaw WB, Cain KA, Francis PS (1997) An updated national survey on seclusion and restraint. Psychiatr Serv 48:395–397PubMedGoogle Scholar
  8. 8.
    Currier GW, Farley-Toombs C (2002) Datapoints: use of restraint before and after implementation of the new HCFA rules. Psychiatr Serv 53:138PubMedCrossRefGoogle Scholar
  9. 9.
    Donat DC (2003) An analysis of successful efforts to reduce the use of seclusion and restraint at a public psychiatric hospital. Psychiatr Serv 54:1119–1123PubMedCrossRefGoogle Scholar
  10. 10.
    Donovan A, Plant R, Peller A, Siegel L, Martin A (2003) Two-year trends in the use of seclusion and restraint among psychiatrically hospitalized youths. Psychiatr Serv 54:987–993PubMedCrossRefGoogle Scholar
  11. 11.
    D’Orio BM, Purselle D, Stevens D, Garlow SJ (2004) Reduction of episodes of seclusion and restraint in a psychiatric emergency system. Psychiatr Serv 55:581–583PubMedCrossRefGoogle Scholar
  12. 12.
    Fisher WA (1994) Seclusion and restraint: a review of the literature. Am J Psychiatry 151:1584–1591PubMedGoogle Scholar
  13. 13.
    Flannery RB, Juliano J, Cronin S, Walker AP (2006) Characteristics of assaultive psychiatric patients: fifteen-year analysis of the assaulted staff action program (ASAP). Psychiatr Q 77:239–249PubMedCrossRefGoogle Scholar
  14. 14.
    Jonikas JA, Cook JA, Rosen C, Laris A, Kim J-B (2004) Brief reports: a program to reduce use of physical restraint in psychiatric inpatient facilities. Psychiatr Serv 55:818–820PubMedCrossRefGoogle Scholar
  15. 15.
    Korkeila J (1998) Perspectives on the public psychiatric services in Finland. Stakes, research report 93. Gummerus Printing, Jyväskylä, FinlandGoogle Scholar
  16. 16.
    Korkeila J, Tuohimäki C, Kaltiala-Heino R, Lehtinen V, Joukamaa M (2002) Predicting use of coercive measures in Finland. Nord J Psychiatry 56:339–345PubMedCrossRefGoogle Scholar
  17. 17.
    Lendemeijer B, Shortridge-Baggett L (1997) The use of seclusion in psychiatry: a literature review. Sch Inq Nurs Pract 11:299–315PubMedGoogle Scholar
  18. 18.
    McCrue RE, Urcuyo L, Lilu Y (2004) Reducing restraint use in a public psychiatric inpatient service. J Behav Health Serv Res 31:217–224Google Scholar
  19. 19.
    Mental Health Act (2004) So 409. In: Suomen Laki II. [Finnish Law II]. Talentum Media Oy, Helsinki, pp 1598–1605Google Scholar
  20. 20.
    Niveau G (2004) Preventing human rights abuses in psychiatric establishments: the work of the CPT. Eur Psychiatry 19:146–154PubMedCrossRefGoogle Scholar
  21. 21.
    Okin RL (1985) Variation among state hospitals in use of seclusion and restraint. Hosp Community Psychiatry 36:648–652PubMedGoogle Scholar
  22. 22.
    Pirkola S, Sohlman B (eds) (2005) Atlas of mental health – statistics from Finland. National Research and Development Centre for Welfare and Health (Stakes), Helsinki, FinlandGoogle Scholar
  23. 23.
    Sailas E, Fenton M (2000) Seclusion and restraint for people with serious mental illnesses (Cochrane Review). The Cochrane Database Syst Rev 2:CD001163Google Scholar
  24. 24.
    Sailas E, Wahlbeck K (2005) Seclusion and restraint in psychiatric inpatient wards. Curr Opin Psychiatry 18:555–559PubMedCrossRefGoogle Scholar
  25. 25.
    Salib E, Ahmed AG, Cope M (1998) Practice of seclusion: a five-year retrospective review in North Cheshire. Med Sci Law 38:321–327PubMedGoogle Scholar
  26. 26.
    Way BB, Banks SM (1990) Use of seclusion and restraint in public psychiatric hospitals: patient characteristics and facility effects. Hosp Community Psychiatry 41:75–81PubMedGoogle Scholar
  27. 27.
    World Psychiatric Association (1996) Declaration of Madrid. 10th World Congress of Psychiatry, Madrid, SpainGoogle Scholar

Copyright information

© Springer-Verlag 2007

Authors and Affiliations

  • Alice Keski-Valkama
    • 1
  • Eila Sailas
    • 2
    • 3
  • Markku Eronen
    • 1
  • Anna-Maija Koivisto
    • 4
    • 5
  • Jouko Lönnqvist
    • 6
    • 7
  • Riittakerttu Kaltiala-Heino
    • 4
    • 8
  1. 1.Vanha Vaasa HospitalVaasaFinland
  2. 2.National Research Centre for Welfare and HealthHelsinkiFinland
  3. 3.Kellokoski HospitalKellokoskiFinland
  4. 4.Tampere School of Public Health, University of TampereTampereFinland
  5. 5.Tampere University Hospital, Research UnitTampereFinland
  6. 6.Dept. of Mental Health and Alcohol ResearchNational Public Health InstituteHelsinkiFinland
  7. 7.Dept. of PsychiatryUniversity of HelsinkiHelsinkiFinland
  8. 8.Psychiatric Treatment and Research Unit for Adolescent Intensive Care (EVA)Tampere University HospitalPitkäniemiFinland

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