title: Comparison of restraint data from four countries.
abstract: BACKGROUND
  Previous studies comparing restraint data from different countries had to rely on randomly published data and showed wide variance in the prevalence of restraint between countries.
  
  
  OBJECTIVE
  To systematically compare datasets from four similar European countries with regard to restraint prevalence.
  
  
  METHODS
  We analysed whole country or area datasets on restraint from Wales, Ireland, Germany and the Netherlands systematically, thus excluding selection, patient and setting bias. Learning disability (LD) and forensic settings were analysed separately. Differences in proportions between countries were tested by means of Chi square, with number of admissions, admission days and catchment area as denominator and counts of restraint as numerators.
  
  
  RESULTS
  Full datasets were obtained allowing calculations of total admissions, total restraint numbers, numbers of patients involved and total occupied bed days. Data for Ireland is from 2012 and from 2013 for the other three countries. The percentage of patients exposed to restraint varies between 4.5 and 9.4 %. The average number of restraints per patient is stable at around 3 in all countries. Patient numbers affected by restraint per 100 occupied bed days per month vary between 0.095 and 0.200. The Netherlands have the highest use of seclusion (79 %), the longest restraint times and low use of enforced medication. Wales the lowest use of seclusion (2 %), followed by Ireland (29 %) and Germany (49 %). Events per 100 admissions per month vary between 17 and 21. Patients affected by restraint per 100 admissions per month vary between 5.4 and 7.5. LD services account for a disproportionately high number of restraint events.
  
  
  CONCLUSIONS
  Patient related restraint data are remarkably similar between countries. Type and length of restraint still vary significantly.
authors.affiliation: Centre for Mental Health and Society, Wrexham Academic Unit, Bangor University, Croesnewydd Road, Wrexham, LL13 7YP, UK.|Consultant Psychiatrist, Betsi Cadwaladr University Health Board, North Wales, UK.|Mysore Medical College and Research Institute, Mysore, India.
authors.forename: Peter
authors.initials: P
authors.lastname: Lepping
authors.affiliation: Specialist trainee in psychiatry, Betsi Cadwaladr University Health Board, North Wales, UK.
authors.forename: Barkat
authors.initials: B
authors.lastname: Masood
authors.affiliation: Medical Controller Department of the Mental Health Services, Research Centres for Psychiatry, Südwürttemberg Weingartshofer Street 2, 88214, Ravensburg, Weissenau, Germany.
authors.forename: Erich
authors.initials: E
authors.lastname: Flammer
authors.affiliation: Head of Research GGnet Community Mental Health Centre, Vordenseweg 12, 7231 PA, Warnsveld, The Netherlands. e.noorthoorn@ggnet.nl.|Dutch Information Center for Coercive Measures, Stichting Benchmark GGZ, Rembrandtlaan 46, 3723 BK, Bilthoven, The Netherlands. e.noorthoorn@ggnet.nl.
authors.forename: Eric O
authors.initials: EO
authors.lastname: Noorthoorn
mesh_terms: D002391:Catchment Area, Health; D005858:Germany; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007494:Ireland; D007902:Length of Stay / Q000706:statistics & numerical data; D001523:Mental Disorders; D009426:Netherlands; D010356:Patient Isolation / Q000706:statistics & numerical data*; D015995:Prevalence; D011567:Psychiatric Department, Hospital; D012149:Restraint, Physical / Q000706:statistics & numerical data*; D013997:Time Factors; D014852:Wales
keywords: Comparison; Overview; Restraint; Seclusion; Standard national figures