Citation

Verlinde AA, Noorthoorn EO, Snelleman W, van den Berg H, Snelleman-van der Plas M, Lepping P. Eur. Psychiatry 2016; 39: 86-92.

Affiliation

Wrexham community mental health team, Betsi Cadwaladr university health board, Ty Derbyn, Wrexham Maelor hospital, Wrexham, Wales, United Kingdom; Centre for mental health and society Bangor university, Bangor, county of Gwynedd North Wales, United Kingdom; Mysore medical college and research institute, Mysore, India.

Copyright

(Copyright © 2016, Elsevier Publishing)

DOI

10.1016/j.eurpsy.2016.08.002

PMID

27992811

Abstract

BACKGROUND: In the Netherlands, seclusion is historically the measure of first choice in dealing with aggressive incidents. In 2010, the Mediant Mental Health Trust in Eastern Netherlands introduced a policy prioritising the use of enforced medication to manage aggressive incidents over seclusion. The main goal of the study was to investigate whether prioritising enforced medication over seclusion leads to a change of aggressive incidents and coercive measures.

METHODS: The study was carried out with data from 2764 patients admitted between 2007 and 2013 to the hospital locations of the Mediant Mental Health Trust in Eastern Netherlands, with a catchment area of 500,000 inhabitants. Seclusion, restraint and enforced medications as well as other coercive measures were gathered systematically. Aggressive incidents were assessed with the SOAS-R. An event sequence analysis was preformed, to assess the whether seclusion, restraint or enforced medication were used or not before or after aggressive incidents.

RESULTS: Enforced medication use went up by 363% from a very low baseline. There was a marked reduction of overall coercive measures by 44%. Seclusion hours went down by 62%. Aggression against staff or patients was reduced by 40%.

CONCLUSIONS: When dealing with aggression, prioritising medication significantly reduces other coercive measures and aggression against staff, while within principles of subsidiarity, proportionality and expediency.

Copyright © 2016 Elsevier Masson SAS. All rights reserved.

Language: en