Economic data on interventions for reducing aggression and restrictive interventions in inpatient mental health: a...

Given the importance of economic considerations for the uptake of interventions into psychiatric policy and practice, this systematic review appraises existing economic evaluations of interventions that aim to reduce aggression and restrictive interventions in inpatient mental health settings.

Eight economic and scientific databases, along with targeted Google Scholar searches, were surveyed for gray and peer-reviewed literature from 01/2000 to 08/2025. Selection criteria included: (1) quantitative studies in peer-reviewed journals or grey literature, (2) a broad range of economic evaluation methods (costs, cost analysis, cost-effectiveness, and cost-benefit), (3) non-geriatric adults and emerging adults (≥ 15 years old) in (4) psychiatric inpatient settings, and (5) non-pharmacological interventions targeting aggression, violence and/or restrictive interventions (e.g., seclusion, restraints, forced medication). Narrative synthesis is presented with a quality appraisal using the CHEERS reporting checklist 2022.

Twenty studies were selected, with the majority conducted in acute wards. Eleven studies reported only the cost of interventions, prominently featuring the cost of restrictive interventions, sensory modulation, and staff training. Moreover, twelve studies reported savings, eight of which allowed cost-analyses. Two interventions yielded clinical benefits and net savings. Assessment of reporting quality revealed few sensitivity analyses to model uncertainty, heterogeneity or distributional effects.

While this review intended to guide organizations in selecting interventions, the current state of evidence can provide some evidence on the cost-benefit of a handful of interventions and re-affirms the costliness of restrictive interventions. Future pre-post studies may benefit from methods featured in this review to estimate the cost of professional time and partner with organizations to access internal financial data. There remains a need for purposeful cost-effectiveness analyses and for demonstrated long-term clinical benefits to inform interventions for aggression management.