The reasons for using restraint and seclusion in psychiatric inpatient care: A nationwide 15-year study.
BACKGROUND
The containment or the prevention of actual violence is the primary justification for the use of restraint and seclusion in psychiatry. The aim of the present study was to determine the grounds for using restraint and seclusion in clinical practice in Finland, and whether these reasons have changed over a 15-year period as a result of legislative changes.


METHODS
A structured postal survey concerning the reasons for restraint and seclusion was completed in all the Finnish psychiatric hospitals during a predetermined week in 1990, 1991, 1994, 1998 and 2004. The duration of the episode as well as demographic and clinical information on the restrained and secluded patient were also reported.


RESULTS
Agitation/disorientation was the most frequent reason for the use of restraint and seclusion. The duration of the restraint and seclusion episodes was not determined by the reason for using these measures. Some differences in the reasons were found among subgroups of patients.


CONCLUSIONS
Clinical practice deviates from the theoretical and legal grounds established for restraint and seclusion, and is too open to subjective assessment and interpretations.
Keski-Valkama
Alice
A
Vanha Vaasa Hospital, 65381 Vaasa, 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; D003068:Coercion; D003625:Data Collection; D005260:Female; D005387:Finland; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D008875:Middle Aged; D010356:Patient Isolation / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D011595:Psychomotor Agitation / Q000523:psychology / Q000628:therapy; D012149:Restraint, Physical / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data*; D017751:Safety Management / Q000706:statistics & numerical data; D014600:Utilization Review / Q000706:statistics & numerical data; D014754:Violence / Q000517:prevention & control / Q000523:psychology; D055815:Young Adult