Social Psychiatry and Psychiatric Epidemiology

, Volume 45, Issue 11, pp 1087–1093 | Cite as

Who are the restrained and secluded patients: a 15-year nationwide study

  • Alice Keski-ValkamaEmail author
  • Eila Sailas
  • Markku Eronen
  • Anna-Maija Koivisto
  • Jouko Lönnqvist
  • Riittakerttu Kaltiala-Heino
Original Paper



To find interventions for reducing the use of restraint and seclusion, it is necessary to identify who the restrained and secluded patients are. The aim of the present study was to determine which demographic and clinical groups of psychiatric inpatients are at risk of being restrained/secluded, and whether there have been changes in the restrained/secluded patients’ profiles over a 15-year period in Finland.


A structured postal survey concerning the demographic and clinical information of restrained/secluded patients was completed in all Finnish psychiatric hospitals during a predetermined week in 1990, 1991, 1994, 1998, and 2004. The National Hospital Discharge Register was used to gather information on all psychiatric inpatients during the study weeks.


Out of the variables studied (age, gender, main diagnosis, phase of hospital stay), only the main diagnosis and the phase of hospital stay were independent risk factors for restraint/seclusion, and remained constant over time. The age profile of the restrained/secluded patients was unstable over time and the risk of being restrained/secluded was not associated with gender.


Restraint and seclusion is used mainly among the acute and the most disturbed patients. Therefore, in order to reduce the use of restraint and seclusion, resources should be targeted especially to these groups.


Seclusion Restraint Coercion 


  1. 1.
    Abderhalden C, Needham I, Dassen T, Halfens R, Haug HJ, Fischer JE (2008) Structured risk assessment and violence in acute psychiatric wards: randomised controlled trial. Br J Psychiatry 193:44–50CrossRefPubMedGoogle Scholar
  2. 2.
    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
  3. 3.
    Bindman J, Reid Y, Szmukler G, Tiller J, Thornicroft G, Leese M (2005) Perceived coercion at admission to psychiatric hospital and engagement with follow-up—a cohort study. Soc Psychiatry Psychiatr Epidemiol 40:160–166CrossRefPubMedGoogle Scholar
  4. 4.
    Brown JS, Tooke SK (1992) On the seclusion of psychiatric patients. Soc Sci Med 35:711–721CrossRefPubMedGoogle Scholar
  5. 5.
    Carpenter MD, Hannon VR, McCleery G, Wanderling JA (1988) Ethnic differences in seclusion and restraint. J Nerv Ment Dis 176:726–731CrossRefPubMedGoogle Scholar
  6. 6.
    Crenshaw WB, Cain KA, Francis PS (1997) An updated national survey on seclusion and restraint. Psychiatr Serv 48:395–397PubMedGoogle Scholar
  7. 7.
    El-Badri SM, Mellsop G (2002) A study of the use of seclusion in an acute psychiatric service. Aust N Z J Psychiatry 36:399–403CrossRefPubMedGoogle Scholar
  8. 8.
    Forquer SL, Earle KA, Way BB, Banks SM (1996) Predictors of the use of restraint and seclusion in public psychiatric hospitals. Adm Policy Ment Health 23:527–532CrossRefGoogle Scholar
  9. 9.
    Gaskin CJ, Elsom SJ, Happell B (2007) Interventions for reducing the use of seclusion in psychiatric facilities: review of the literature. Br J Psychiatry 191:298–303CrossRefPubMedGoogle Scholar
  10. 10.
    Hammill K (1987) Seclusion: inside looking out. Nurs Times 83:38–39PubMedGoogle Scholar
  11. 11.
    Harris GT, Rice ME (1997) Risk appraisal and management of violent behavior. Psychiatr Serv 48:1168–1176PubMedGoogle Scholar
  12. 12.
    Isohanni M, Mäkikyrö T, Moring J, Räsänen P, Hakko H, Partanen U, Koiranen M, Jones P (1997) A comparison of clinical and research DSM-III-R diagnoses of schizophrenia in a Finnish national birth cohort. Clinical and research diagnoses of schizophrenia. Soc Psychiatry Psychiatr Epidemiol 32:303–308CrossRefPubMedGoogle Scholar
  13. 13.
    Kaltiala-Heino R, Korkeila J, Tuohimäki C, Tuori T, Lehtinen V (2000) Coercion and restrictions in psychiatric inpatient treatment. Eur Psychiatry 15:213–219CrossRefPubMedGoogle Scholar
  14. 14.
    Keski-Valkama A, Sailas E, Eronen M, Koivisto AM, Lönnqvist J, Kaltiala-Heino R (2007) A 15-year national follow-up: legislation is not enough to reduce the use of seclusion and restraint. Soc Psychiatry Psychiatr Epidemiol 42:747–752CrossRefPubMedGoogle Scholar
  15. 15.
    Kirkpatrick H (1989) A descriptive study of seclusion: the unit environment, patient behavior, and nursing interventions. Arch Psychiatr Nurs 3:3–9PubMedGoogle Scholar
  16. 16.
    Legris J, Walters M, Browne G (1999) The impact of seclusion on the treatment outcomes of psychotic inpatients. J Adv Nurs 30:448–459CrossRefPubMedGoogle Scholar
  17. 17.
    Mason T (1998) Gender differences in the use of seclusion. Med Sci Law 38:2–9PubMedGoogle Scholar
  18. 18.
    Pihlajamaa J, Suvisaari J, Henriksson M, Heila H, Karjalainen E, Koskela J, Cannon M, Lönnqvist J (2008) The validity of schizophrenia diagnosis in the Finnish Hospital Discharge Register: findings from a 10-year birth cohort sample. Nord J Psychiatry 62:198–203CrossRefPubMedGoogle Scholar
  19. 19.
    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
  20. 20.
    Smith GM, Davis RH, Bixler EO, Lin HM, Altenor A, Altenor RJ, Hardentstine BD, Kopchick GA (2005) Pennsylvania State Hospital system’s seclusion and restraint reduction program. Psychiatr Serv 56:1115–1122CrossRefPubMedGoogle Scholar
  21. 21.
    Steinert T, Lepping P, Bernhardsgrutter R, Conca A, Hatling T, Janssen W, Keski-Valkama A, Mayoral F, Whittington R (2009) Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends. Soc Psychiatry Psychiatr EpidemiolGoogle Scholar
  22. 22.
    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 42:140–145CrossRefPubMedGoogle Scholar
  23. 23.
    Tardiff K (1981) Emergency control measures for psychiatric inpatients. J Nerv Ment Dis 169:614–618CrossRefPubMedGoogle Scholar
  24. 24.
    Thompson P (1986) The use of seclusion in psychiatric hospitals in the Newcastle area. Br J Psychiatry 149:471–474CrossRefPubMedGoogle Scholar
  25. 25.
    Wallsten T, Kjellin L, Lindström L (2006) Short-term outcome of inpatient psychiatric care—impact of coercion and treatment characteristics. Soc Psychiatry Psychiatr Epidemiol 41:975–980CrossRefPubMedGoogle 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.
    Wynn R (2003) Staff’s attitudes to the use of restraint and seclusion in a Norwegian university psychiatric hospital. Nord J Psychiatry 57:453–459CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag 2009

Authors and Affiliations

  • Alice Keski-Valkama
    • 1
    Email author
  • Eila Sailas
    • 2
  • Markku Eronen
    • 1
  • Anna-Maija Koivisto
    • 3
  • Jouko Lönnqvist
    • 4
    • 5
  • Riittakerttu Kaltiala-Heino
    • 6
    • 7
  1. 1.Vanha Vaasa HospitalVaasaFinland
  2. 2.Kellokoski HospitalKellokoskiFinland
  3. 3.Tampere School of Public HealthTampereTampereFinland
  4. 4.Department of Mental Health and Substance Use DisorderNational Institute for Health and WelfareHelsinkiFinland
  5. 5.Department of PsychiatryUniversity of HelsinkiHelsinkiFinland
  6. 6.Medical SchoolUniversity of TampereTampereFinland
  7. 7.Department of Adolescent PsychiatryTampere University HospitalTampereFinland

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