Measures to Avoid Coercion in Psychiatry and Their Efficacy

Area of Science:

• Psychiatry
• Clinical Psychology
• Healthcare Management

Background:

• Coercive measures like seclusion and restraint infringe on patient rights and carry risks.
• These measures are sometimes necessary to prevent immediate harm to patients or staff.
• Effective strategies for avoiding coercion in psychiatric settings are crucial.

Purpose of the Study:

• To review the efficacy of interventions designed to prevent or reduce the use of coercive measures in psychiatry.
• To synthesize evidence on various approaches to minimizing seclusion and restraint.

Main Methods:

• Systematic literature search of Medline and Cinahl databases.
• Narrative synthesis categorizing interventions by content (organization, staff training, risk assessment, environment, psychotherapy, debriefings, advance directives).
• Inclusion of 84 studies, with 16 having control groups, including 6 randomized controlled trials (RCTs).

Main Results:

• Most interventions across categories demonstrated effectiveness in reducing coercion.
• Complex intervention programs, integrating multiple elements, were particularly effective.
• Two RCTs showed significant reductions: 27% fewer seclusion measures and 45% less cumulative seclusion duration using risk assessment tools.

Conclusions:

• Multi-component intervention programs are highly effective in reducing psychiatric coercion.
• Further cluster-randomized trials are needed to evaluate the impact of individual intervention categories.