The use of coercive measures in adolescent psychiatric inpatient treatment: a nation-wide register study

Purpose To evaluate the extent and trends in the use of seclusion/restraint in psychiatric inpatient treatment of adolescents aged 12–17 years in Finland. Methods The National Hospital Discharge Register data comprising all psychiatric inpatient treatment periods of 12- to 17 year-olds in Finland during the period 1996–2003 was used. Time trends, regional variation and patient characteristics related to the risk of being subjected to seclusion/restraint in psychiatric inpatient treatment are reported. Results The average prevalence of use of seclusion and restraint was 1.71/10,000/year over the study period. Use of seclusion/restraint in adolescent psychiatric inpatient care first increased, peaking in 1999–2001, and then decreased. The decrease occurred after stricter legislative control of use of seclusion/restraint was introduced in 2002, despite that involuntary treatment periods did not decrease. Considerable regional variation was seen in the use of seclusion/restraint. A greater proportion of girls than boys were secluded/restrained. Seclusion/restraint was most common in schizophrenia, mood disorders and conduct disorder. Conclusions Legislative control had the desired immediate impact on the use of seclusion/restraint in adolescent psychiatric inpatient care. Legislative control is, however, not strong enough to ensure homogenous practices across the country, as there is many-fold regional variation in figures for using seclusion and restraint.