Trends in the use of coercive measures in Finnish psychiatric hospitals: a register analysis of the past two decades

Maritta Välimäki, Min Yang, Tero Vahlberg, Tella Lantta, Virve Pekurinen, Minna Anttila, Sharon-Lise Normand, Maritta Välimäki, Min Yang, Tero Vahlberg, Tella Lantta, Virve Pekurinen, Minna Anttila, Sharon-Lise Normand

Abstract

Background: Coercive measures is a topic that has long been discussed in the field of psychiatry. Despite global reports of reductions in the use of restraint episodes due to new regulations, it is still questionable if practices have really changed over time. For this study, we examined the rates of coercive measures in the inpatient population of psychiatric care providers across Finland to identify changing trends as well as variations in such trends by region.

Methods: In this nationwide registry analysis, we extracted patient data from the national database (The Finnish National Care Register for Health Care) over a 20-year period. We included adult patients admitted to psychiatric units (care providers) and focused on patients who had faced coercive measures (seclusion, limb restraints, forced injection and physical restraints) during their hospital stay. Multilevel logistical models (a polynomial model of quadratic form) were used to examine trends in prevalence of any coercive measures as well as the other four specified coercive measures over time, and to investigate variation in such trends among care providers and regions.

Results: Between 1995 and 2014, the dataset contained 226,948 inpatients who had been admitted during the 20-year time frame (505,169 treatment periods). The overall prevalence of coercive treatment on inpatients was 9.8%, with a small decrease during 2011-2014. The overall prevalence of seclusion, limb restraints, forced injection and physical restraints on inpatients was 6.9, 3.8, 2.6 and 0.8%, respectively. Only the use of limb restraints showed a downward trend over time. Geographic and care provider variations in specific coercive measures used were also observed.

Conclusions: Despite the decreasing national level of coercive measures used in Finnish psychiatric hospitals, the overall reduction has been small during the last two decades. These results have implications on the future development of structured guidelines and interventions for preventing and more effectively managing challenging situations. Clinical guidelines and staff education related to the use of coercive measures should be critically assessed to ensure that the staff members working with vulnerable patient populations in psychiatric hospitals are ethically competent.

Keywords: Aggression; Coercive measures; Psychiatry; Register; Trends.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Time trend of prevalence of any coercive treatment method by patient gender with 95% confidence intervals (CI): raw data
Fig. 2
Fig. 2
Gender difference in time trend of prevalence of different coercive treatment methods: raw data
Fig. 3
Fig. 3
Time trend of prevalence of different coercive treatment methods: raw data and smoothed curve by quadratic function
Fig. 4
Fig. 4
Model-estimated prevalence trends by type of coercive treatment methods (based on the reference group of patients: male in 40 years from hospitals with minimum treatment periods in Southern Finland region)
Fig. 5
Fig. 5
Model-estimated prevalence (%) of coercive treatment methods by care providers (each line represents a predicted time trend of coercive treatment use in each care provider or hospital, based on the fully adjusted model)

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