Use of coercive measures during involuntary hospitalization: findings from ten European countries.
OBJECTIVE
Involuntary treatment in mental health care is a sensitive but rarely studied issue. This study was part of the European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice (EUNOMIA) project. It assessed and compared the use of coercive measures in psychiatric inpatient facilities in ten European countries.


METHODS
The sample included 2,030 involuntarily admitted patients. Data were obtained on coercive measures (physical restraint, seclusion, and forced medication).


RESULTS
In total, 1,462 coercive measures were used with 770 patients (38%). The percentage of patients receiving coercive measures in each country varied between 21% and 59%. The most frequent reason for prescribing coercive measures was patient aggression against others. In eight of the countries, the most frequent measure used was forced medication, and in two of the countries mechanical restraint was the most frequent measure used. Seclusion was rarely administered and was reported in only six countries. A diagnosis of schizophrenia and more severe symptoms were associated with a higher probability of receiving coercive measures.


CONCLUSIONS
Coercive measures were used in a substantial group of involuntarily admitted patients across Europe. Their use appeared to depend on diagnosis and the severity of illness, but use was also heavily influenced by the individual country. Variation across countries may reflect differences in societal attitudes and clinical traditions.
Raboch
Jirí
J
Department of Psychiatry, Charles University, First Faculty of Medicine, Prague 2, Czech Republic. raboch@cesnet.cz
Kalisová
Lucie
L
Nawka
Alexander
A
Kitzlerová
Eva
E
Onchev
Georgi
G
Karastergiou
Anastasia
A
Magliano
Lorenza
L
Dembinskas
Algirdas
A
Kiejna
Andrzej
A
Torres-Gonzales
Francisco
F
Kjellin
Lars
L
Priebe
Stefan
S
Kallert
Thomas W
TW
D000328:Adult; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders; D005060:Europe; D005260:Female; D006760:Hospitalization; D006778:Hospitals, Psychiatric; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies