Which patients are in highest risk of coercive measures after admission to a general psychiatric ward
Year: 2017
Type: article
Study design: Observational Study
Abstract: Background Coercive measures, especially mechanical restraint, are more frequently applied to some patients in general psychiatry. In order to tailor an intervention to reduce mechanical restraint we sought to create an evidence base speci c to our population in general psychiatry. Aims To identify possible predictive markers for coercion among general psychiatric inpatients. Methods Systematic analysis of all coercive episodes at ward P2, Department of Psychiatry Haderslev, Denmark during 2015. Data regarding admission, psychiatric diagnosis, substance abuse, type and time of coercive measures were sampled from case records. Results We identi ed 18 coercive episodes in 16 different patients (admissions) from approximately 300 admissions to ward P2 during 2015. Of these 13 episodes (72%) happened within the rst 24 hours following admission. In all episodes the patients were involuntarily admitted, and in 11 episodes (61%) the patient suffered from a psychotic condition. In 9 episodes (50%) the patients were under the in uence of psychoactive substances. Eight patients (44%) had not been taking psychotropic medication in prescribed or suf cient doses, and the same 8 patients had not had regular contact with psychiatric outpatient services prior to admission. Conclusions The majority of coercive episodes happened within the rst 24 hours after admission, and in patients with concurrent psychotic disorder and substance abuse. We propose an intervention based upon these data which includes: Systematic evaluation of violence risk, individual plans for patients in increased risk of violence, systematic analysis of all episodes and near-episodes of coercion, group therapy during admission dedicated towards substance abuse, better staf ng levels and continuous training of staff. This intervention is currently being tested at the Department of Psychiatry in Aabenraa, Denmark and has until now lead to a decrease in episodes with mechanical restraint from 18 in 2015 to 9 in 2016, and only 1 episode in the rst half of 2017.
Institution: Psykiatrien i Region Syddanmark
Language: English
Subfield: Clinical Psychology
Field: Psychology
Domain: Social Sciences
Open Access status: green
Funder: University of Chester
OpenAlex ID: W2767375672