A 15-year national follow-up: legislation is not enough to reduce the use of seclusion and restraint.
BACKGROUND
Seclusion and restraint are frequent but controversial coercive measures used in psychiatric treatment. Legislative efforts have started to emerge to control the use of these measures in many countries. In the present study, the nationwide trends in the use of seclusion and restraint were investigated in Finland over a 15-year span which was characterised by legislative changes aiming to clarify and restrict the use of these measures.


METHODS
The data were collected during a predetermined week in 1990, 1991, 1994, 1998 and 2004, using a structured postal survey of Finnish psychiatric hospitals. The numbers of inpatients during the study weeks were obtained from the National Hospital Discharge Register.


RESULTS
The total number of the secluded and restrained patients declined as did the number of all inpatients during the study weeks, but the risk of being secluded or restrained remained the same over time when compared to the first study year. The duration of the restraint incidents did not change, but the duration of seclusion increased. A regional variation was found in the use of coercive measures.


CONCLUSIONS
Legislative changes solely cannot reduce the use of seclusion and restraint or change the prevailing treatment cultures connected with these measures. The use of seclusion and restraint should be vigilantly monitored and ethical questions should be under continuous scrutiny.
Keski-Valkama
Alice
A
Vanha Vaasa Hospital, PO Box 13, Vaasa, 65381 Finland. alice.keski-valkama@vvs.fi
Sailas
Eila
E
Eronen
Markku
M
Koivisto
Anna-Maija
AM
Lönnqvist
Jouko
J
Kaltiala-Heino
Riittakerttu
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D003068:Coercion; D005260:Female; D005387:Finland / Q000453:epidemiology; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology*; D008605:Mental Health Services / Q000331:legislation & jurisprudence* / Q000592:standards; D008875:Middle Aged; D010351:Patient Discharge / Q000706:statistics & numerical data; D015995:Prevalence; D012042:Registries; D012149:Restraint, Physical / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*