How to prevent Coercion in Danish Mental Health Care-A Longitidinal Cluster Study

Background: The use of physical coercive measures, e.g. mechanical restraint (MR), in mental health care, is a major infringement on the psychiatric patient’s autonomy. MR can cause physical and mental harm but may be necessary to avoid putting an individual’s health at risk. The nursing staff is tasked with protecting the life and health of, not only the individual patient, but also other patients, and relatives. A situation can occur in which staff is obligated to use force, and occasionally MR, if a patient is very aggressive, violent, self-destructive, or suicidal. Although MR is legal, the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment concluded, in three reports from 2002, 2008, and 2014 that no medical justification exists for applying instruments of physical restraint to psychiatric patients for days, and that doing so amounts to ill treatment. Following, the Government in Denmark decided in 2014, that the number of MR should be halved before 2020. This decision lead to development, and implementation of an array of more or less, evidence based preventive initiatives. In some regions, the development has been positive, reducing the numbers of MR episodes, but we do not know which initiatives has created this development. Aim: To examine which MR preventive factors/initiatives reduces the number of MR episodes. Methods: This study is designed as a nationwide, longitudinal, cluster, cross-sectional survey of preventive initiatives implemented in psychiatric units and the corresponding numbers of coercive episodes. Questionnaires will be used to gather data on preventive initiatives from the units’ once a year, over a period of three years, and data on coercive episodes will be accessed from the national database on coercion. A linear mixed-method model will be used to estimate the longitudinal effect of implementing the specific preventive initiatives. Results: The only data collected at the time of the conference will be from 2016, so descriptive data will be presented, together with data on coercive episodes.