Containment Measures in Adolescent Psychiatric Care – Focus on Mechanical Restraint

The overall goal of the study was to describe and enhance the knowledge of the use of containment measures, especially mechanical restraint, in the inpatient psychiatric treatment of adolescents. The contributory goals of this study were to describe nurses’, doctors’ and patients’ attitudes towards various containment measures in adolescent psychiatric wards, to ascertain the extent and nature of the mechanical restraint episodes during a one-year study period, and to describe the patients’ experiences of mechanical restraint during their hospital treatment. The results of this study will provide valuable information for the further development of high standard mechanical restraint practices, both by diminishing their number and by developing the mechanical restraint conventions in the field of adolescent psychiatry. The study aims to improve the clinical care of mechanical restrained patients. The data were collected in four phases between October 2009 and April 2012 on adolescent psychiatric wards in the capital region of Finland. Both the nurses and doctors working in seven closed adolescent psychiatric wards of the Hospital District of Helsinki and Uusimaa (HUS) expressed high levels of approval of containment measures. Adolescents evaluated containment measures more critically than the staff. Adolescents most approved of as-needed medication, intermittent observation and time out. The most disliked method was net bed. Adolescents rated mechanical restraint among the three least tolerated methods. The prevalence of mechanical restraint and the number of lengthy mechanical restraint episodes were high on adolescent psychiatric wards of the present study. Most mechanically restrained adolescents knew the reason for their mechanical restraint, experienced mechanical restraint with ambivalence seeing in it both benefit and harm, yet considered it as a form of punishment. In spite of this, most adolescents considered mechanical restraint as a necessary measure in an adolescent psychiatric hospital setting, mostly because of the violent behaviour of the patients. Adolescents were active commentators with many ideas about how to improve mechanical restraint practices. This dissertation provides new information about the realization of various containment measures and mechanical restraint in adolescent inpatient psychiatric care. In order to improve clinical nursing wide-ranging and in-depth training is needed in adolescent psychiatric wards in order to reduce the use of containment measures. Also, new ways to manage crisis situations should be developed. Information, explanation about the procedures involved and debriefing should be offered to an under-aged patient in a manner which takes into account the developmental level of the adolescent. Reducing the number and shortening the length of mechanical restraint episodes is needed. Adolescent patients should play an active role in developing in-patient aggression management programmes in Finnish adolescent psychiatry.