Correlates of seclusion and restraint of patients admitted to psychiatric inpatient treatment via a German emergency room

J Psychiatr Res. 2020 Nov;130:201-206. doi: 10.1016/j.jpsychires.2020.07.033. Epub 2020 Jul 28.

Abstract

Coercive measures in psychiatry are associated with negative consequences for both patients and staff. When it comes to preventing coercive measures, innovative models of care like the Weddinger Modell focusing on recovery, participation and supported decision-making have proven successful. However, observations from clinical practice show that emergency admissions to psychiatric facilities pose a great challenge in this regard and that most coercive measures take place during or shortly after emergency admission. This study retrospectively examined all cases (N = 1477) admitted to inpatient treatment at the Department of Psychiatry of the Charité at St. Hedwig Hospital in Berlin via the emergency room in 2018 aiming to identify patient characteristics that serve as predictors for coercive measures. Physical aggression, involuntary admission, police referral and younger age were found to be significant predictors (p < .001). Of 218 cases who experienced coercive measures, 81.2% (n = 177) were subjected to seclusion or restraint within the first 24 h of their hospital stay and 56.9% (n = 124) of cases only experienced coercive measures within these first 24 h and were not subjected to any coercive measures after. These results show that certain patient characteristics put individuals at higher risk of being secluded or restrained and that the risk of experiencing coercive measures is highest at the time during and shortly after emergency admission. To prevent coercive measures, it is crucial to target more resources and put in place measures specifically tailored to these emergency situations and the most vulnerable patient groups.

Keywords: Acute psychiatry; Aggression; Coercion; Emergency psychiatry; Restraint; Seclusion.

MeSH terms

  • Coercion
  • Emergency Service, Hospital
  • Hospitals, Psychiatric
  • Humans
  • Inpatients*
  • Mental Disorders* / therapy
  • Patient Isolation
  • Restraint, Physical
  • Retrospective Studies