Reducing seclusion through involuntary medication: a randomized clinical trial.

PURPOSE The study evaluated whether seclusion and coercive incidents would be reduced in extent and number if involuntary medication was the first choice of intervention. Patients admitted to an acute psychiatric ward were randomly allocated to two groups. In Group 1, involuntary medication was the intervention of first choice for dealing with agitation and risk of violence. In Group 2, seclusion was the intervention of first choice. Patients' characteristics between the groups were compared by Pearson χ(2) and two-sample t-tests; the incidence rates and risk ratios (RRs) were calculated to examine differences in number and duration of coercive incidents. In Group 1, the relative risk of being secluded was lower than in Group 2, whereas the risk of receiving involuntary medication was higher. However, the mean duration of the seclusion incidents did not differ significantly between the two groups; neither did the total number of coercive incidents. Although the use of involuntary medication could successfully replace and reduce the number of seclusions, alternative interventions are needed to reduce the overall number and duration of coercive incidents. A new policy for managing acute aggression - such as involuntary medication - can be implemented effectively only if certain conditions are met.