Incidence of seclusion and restraint in psychiatric hospitals: a literature review and survey of international trends.
OBJECTIVE
The aim of this study was to identify quantitative data on the use of seclusion and restraint in different countries and on initiatives to reduce these interventions.


METHODS
Combined literature review on initiatives to reduce seclusion and restraint, and epidemiological data on the frequency and means of use in the 21st century in different countries. Unpublished study was detected by contacting authors of conference presentations. Minimum requirements for the inclusion of data were reporting the incidence of coercive measures in complete hospital populations for defined periods and related to defined catchment areas.


RESULTS
There are initiatives to gather data and to develop new clinical practice in several countries. However, data on the use of seclusion and restraint are scarcely available so far. Data fulfilling the inclusion criteria could be detected from 12 different countries, covering single or multiple hospitals in most counties and complete national figures for two countries (Norway, Finland). Both mechanical restraint and seclusion are forbidden in some countries for ethical reasons. Available data suggest that there are huge differences in the percentage of patients subject to and the duration of coercive interventions between countries.


CONCLUSIONS
Databases on the use of seclusion and restraint should be established using comparable key indicators. Comparisons between countries and different practices can help to overcome prejudice and improve clinical practice.
Steinert
Tilman
T
Centres for Psychiatry Suedwuerttemberg, Ulm University, Weingartshofer Strasse 2, 88214 Ravensburg-Weissenau, Germany. tilman.steinert@zfp-weissenau.de
Lepping
Peter
P
Bernhardsgrütter
Renate
R
Conca
Andreas
A
Hatling
Trond
T
Janssen
Wim
W
Keski-Valkama
Alice
A
Mayoral
Fermin
F
Whittington
Richard
R
D003068:Coercion; D003431:Cross-Cultural Comparison; D006778:Hospitals, Psychiatric / Q000941:ethics / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D015994:Incidence; D001523:Mental Disorders / Q000453:epidemiology / Q000628:therapy; D010356:Patient Isolation / Q000941:ethics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011287:Prejudice; D012149:Restraint, Physical / Q000941:ethics / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*