The Use of Coercion in Four Psychiatric Wards

Abstract

Objective: despite the controversy over the use of coercive means and lack of empirical research on the subject, these measures are commonly used to treat and manage disruptive and violent behavior in psychiatric care. The aim of this study was to examine the use of restraints and pharmacological coercion in four Norwegian acute psychiatric wards, and to investigate predictors for the type of coercive mean.

Methods: data from all cases of restraint and pharmacological coercion (short-term) were retrospectively collected from restraint protocols in four Norwegian acute psychiatric wards and analysed. Over a seven – year period there were 1468 cases of restraints and pharmacological coercion distributed on 320 patients. Logistic regression was used to determine predictors for the type of coercive mean.

Results: restraint was the most common used coercive mean. Females, older patients and patients’ compulsory admitted were most often pharmacological coerced, while males, younger patients and patients with personality disorder were more frequently restrained. A binary logistic regression adjusted for gender, age, legal status of referral and diagnosis revealed that the females and older patients in the study had an increased likelihood of pharmacological coercion. Having a personality disorder decreased the risk of pharmacological coercion with 87 %. The results are only among those patients subjected to coercion.

Conclusion: Salient findings from this study were that restraints were more commonly used than pharmacological restraints. Patients with personality disorder were more at risk of being submitted to restraints that pharmacological coercion. Males were more often restraint than females, and the highest number of coercive action was in the summer and spring.