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Seclusion and enforced medication in dealing with aggression: A prospective dynamic cohort study
A A Verlinde1, E O Noorthoorn2, W Snelleman1
1Mediant mental health trust, 1050 7546 TA Broekheurnering, The Netherlands.
Summary
Prioritizing enforced medication over seclusion significantly reduced aggressive incidents and overall coercive measures in mental health care. This policy shift led to a 40% decrease in aggression and a 62% reduction in seclusion hours.
Area of Science:
- Mental Health Care Policy
- Patient Safety and Aggression Management
- Clinical Practice Interventions
Background:
- Historically, seclusion was the primary method for managing aggression in Dutch mental health settings.
- A policy shift in 2010 prioritized enforced medication over seclusion at Mediant Mental Health Trust.
- The study aimed to evaluate the impact of this policy change on aggressive incidents and coercive measures.
Purpose of the Study:
- To determine if prioritizing enforced medication over seclusion alters the frequency of aggressive incidents.
- To assess the effect of the policy change on the utilization of various coercive measures.
- To analyze the relationship between enforced medication, seclusion, and aggression in a mental health trust.
Main Methods:
- Analysis of data from 2764 patients admitted between 2007 and 2013.
- Systematic collection of data on seclusion, restraint, enforced medications, and other coercive measures.
- Assessment of aggressive incidents using the SOAS-R and event sequence analysis.
Main Results:
- Enforced medication use increased by 363% from a low baseline.
- Overall coercive measures decreased by 44%, with seclusion hours dropping by 62%.
- Aggression against staff and patients was reduced by 40%.
Conclusions:
- Prioritizing enforced medication over seclusion is an effective strategy for managing aggression.
- This approach significantly reduces other coercive measures and patient-on-staff aggression.
- The policy aligns with principles of subsidiarity, proportionality, and expediency in mental health care.
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