Seclusion, restraint, and involuntary medication in Finnish psychiatric care: a register study with root-level data

Abstract

Purpose: Despite potentially harmful effects, seclusion, restraint, and involuntary medication continue to be frequently applied in psychiatric care. These restrictive measures are often examined by means of registers, but homogeneous practices in the measurement and description seem to be missing. This nationwide register study aimed to examine the use of seclusion, mechanical and physical restraint, and involuntary medication in Finland.

Material and methods: Root-level register data concerning the year 2017 were collected directly from 140 inpatient psychiatric wards within 21 organizations. The data were analyzed statistically.

Results: In 2017, the most used restrictive measure in Finnish psychiatric wards was seclusion (4006 episodes), followed by involuntary medication (2187 episodes), mechanical restraint (2113 episodes) and physical restraint (1064 events). Similarly, the duration of seclusion episodes was longer than the duration of restraint episodes. Remarkable variation between wards in the use of seclusion, restraint and involuntary medication was observable. A negative binomial regression model (NB2) was used to analyze the associations between the use of restrictive measures and regional variables concerning demography, health, substance abuse, and socio-economic status, but reliable interpretations were impossible to generate.

Conclusion: This study provides detailed and unique data on the use of seclusion, restraint and involuntary medication in Finland. Compared to previous national-level data, this study highlights the importance of collecting root-level data. Future research should use registries and describe the associations between the use of restrictive measures and ward-level factors, patient-level characteristics, and societal factors.

Keywords:

• Psychiatric care
• seclusion
• restraint
• involuntary medication
• registers

Ethical statement

The University of Eastern Finland Committee on Research Ethics provided a supportive statement for this research in January 2017. Research permission was also obtained from all of the organizations that participated in this study.

Acknowledgements

The authors thank Secretary Aija Räsänen and Research Secretary Tarja Koskela from Niuvanniemi Hospital for their valuable help during the research process. The authors thank everyone who participated in the data collection. This work was funded by the Finnish Ministry of Health and Social Affairs through the development fund for Niuvanniemi Hospital, Kuopio, Finland and by the Finnish Cultural Foundation, North Savo Regional fund. The researchers were independent from the funders.

Authorship statement

All of the listed authors meet authorship criteria according to the latest guidelines of the International Committee of Medical Journal Editors, and all authors are in agreement with the submission of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was funded by the Finnish Ministry of Health and Social Affairs through the development fund for Niuvanniemi Hospital, Kuopio, Finland and by the Finnish Cultural Foundation, North Savo Regional fund. The researchers were independent from the funders.

Notes on contributors

Emilia Laukkanen

Emilia Laukkanen is a PhD student in the University of Eastern Finland, Faculty of Health Sciences.

Lauri Kuosmanen

Lauri Kuosmanen is a professor of preventive nursing science in the University of Eastern Finland, Faculty of Health Sciences.

Tuomas Selander

Tuomas Selander is a biostatistician in Kuopio University Hospital.

Katri Vehviläinen-Julkunen

Katri Vehviläinen-Julkunen is a professor of nursing and Director of the Doctoral Program in Health Sciences in the University of Eastern Finland, Faculty of Health Sciences. She also holds a part-time position in Kuopio University Hospital.