Who are the restrained and secluded patients: a 15-year nationwide study

To find interventions for reducing the use of restraint and seclusion, it is necessary to identify who the restrained and secluded patients are. The aim of the present study was to determine which demographic and clinical groups of psychiatric inpatients are at risk of being restrained/secluded, and whether there have been changes in the restrained/secluded patients' profiles over a 15-year period in Finland. A structured postal survey concerning the demographic and clinical information of restrained/secluded patients was completed in all Finnish psychiatric hospitals during a predetermined week in 1990, 1991, 1994, 1998, and 2004. The National Hospital Discharge Register was used to gather information on all psychiatric inpatients during the study weeks. Out of the variables studied (age, gender, main diagnosis, phase of hospital stay), only the main diagnosis and the phase of hospital stay were independent risk factors for restraint/seclusion, and remained constant over time. The age profile of the restrained/secluded patients was unstable over time and the risk of being restrained/secluded was not associated with gender. Restraint and seclusion is used mainly among the acute and the most disturbed patients. Therefore, in order to reduce the use of restraint and seclusion, resources should be targeted especially to these groups.