Engelsk titel: Coercion in psychiatry: the importance of extramural factors
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Författare:
Andersen, Kjeld
;
Nielsen, Bent
Email: kjeld.andersen@rsyd.dk
Språk: Eng
Antal referenser: 21
Dokumenttyp:
Artikel
UI-nummer: 16123695
Sammanfattning
Background: Mechanical restraints and forced procedures in psychiatric wards are of major
concern in Denmark and there is a desire to reduce these procedures to a minimum. So far, focus has
primarily been on identifying and changing internal (intramural) factors when seeking to reduce
coercion.
Aim: To identify possible external (extramural) factors that may increase the risk of coercion during
admission to a closed psychiatric ward.
Method: Using a retrospective case-controlled design, 235 patients admitted to a closed ward during
2011-2013 were randomly selected. Coercion comprised belt restraint, physical restraint, and forced
medication. The data source was the electronic patient records, which include statutory information
on all forced measures. Multiple logistic regression analyses were applied to calculate the risk (odds
ratio, OR (95% confidence interval)) of forced measures being used.
Results: Out of the 235 patients, 66 (28%) were subject to coercion. The time of forced procedures
was predominately during the first hours after admission. The risk of forced measures being applied
was significantly higher if patients were involuntarily admitted (OR = 6.4 (3.4 11.9)), or were acutely
intoxicated by substances at the time of admission (OR = 3.7 (1.7-8.2)).
Conclusion: Extramural factors should be included when mental health authorities plan efforts to
reduce coercion during admission to psychiatric wards. A reduced threshold for admission and
improved integrated effort between mental health services and treatment for substance abuse could
improve the course of disease for this group of patients and reduce the need for involuntary
admissions and subsequently coercion.