Ham Elke, Kim Soyeon, Hilton N Zoe
Waypoint Research Institute, Waypoint Centre for Mental Health Care, Penetanguishene, Ontario, Canada.
Psychiatry and Behavioral Neurosciences, McMaster University, Hamilton, Ontario, Canada.
PLoS One. 2025 Jul 23;20(7):e0328164. doi: 10.1371/journal.pone.0328164. eCollection 2025.
The use of coercive measures such as seclusion and restraint in forensic mental healthcare settings is widespread but controversial. Efforts to reduce these measures require knowledge of patient-related risk factors. The present study aimed to identify and confirm factors related to seclusion and restraint that can be assessed upon admission among men and women admitted to forensic hospitals in Ontario, Canada. We included cross-sectional Ontario Mental Health Reporting System admission data for adult patients admitted to 10 forensic psychiatric hospitals between April 1, 2013, and March 31, 2023. We determined patient demographic, administrative, and clinical characteristics associated with seclusion and physical and manual restraint episodes during the first three days of admission. We conducted logistic Generalized Linear mixed Models (GLMM) to examine the association between the independent variables and restraint and seclusion while accounting for variability across facilities. Of 7635 patients, 30.2% (n = 2302) were secluded, and 3.7% (n = 286) were restrained within their first three days of admission. Secluded patients were more likely to be young adults, male, and scored higher on violence and aggression measures. Being admitted due to fitness-related reasons, lack of insight, medication non-adherence, higher scores on the mania scale and cognitive impairment further contributed to the higher odds of being secluded, whereas neurocognitive disorder diagnosis and elopement behavior were protective factors. Restrained patients were also more likely to be young adults, have a diagnosis of mood or anxiety, neurodevelopmental or personality disorder, and scored higher on violence and aggression measures. Fitness-related status, medication non-adherence, and cognitive impairment further contributed to this model of restraint. Indigenous self-identification and immigration status were not significant contributors to either model. Clinicians can assess indicators associated with seclusion and restraint when forensic patients are admitted to forensic hospitals or during the first three days of their stay, enabling effective targeting of those needs to reduce the use of coercive measures.
在法医精神卫生保健环境中，使用隔离和约束等强制措施很普遍，但存在争议。减少这些措施的努力需要了解与患者相关的风险因素。本研究旨在识别并确认与隔离和约束相关的因素，这些因素可在加拿大安大略省法医医院收治的男性和女性入院时进行评估。我们纳入了安大略省心理健康报告系统的横断面入院数据，这些数据来自2013年4月1日至2023年3月31日期间入住10家法医精神病医院的成年患者。我们确定了与入院头三天内的隔离以及身体和手动约束事件相关的患者人口统计学、管理和临床特征。我们进行了逻辑广义线性混合模型（GLMM），以检验自变量与约束和隔离之间的关联，同时考虑各机构之间的变异性。在7635名患者中，30.2%（n = 2302）在入院头三天内被隔离，3.7%（n = 286）被约束。被隔离的患者更有可能是年轻成年人、男性，并且在暴力和攻击行为测量中得分更高。因与健康相关的原因入院、缺乏洞察力、不遵医嘱服药、躁狂量表得分较高以及认知障碍进一步导致被隔离的几率更高，而神经认知障碍诊断和逃跑行为则是保护因素。被约束的患者也更有可能是年轻成年人，被诊断患有情绪或焦虑、神经发育或人格障碍，并且在暴力和攻击行为测量中得分更高。与健康相关的状况、不遵医嘱服药和认知障碍进一步促成了这种约束模式。原住民自我认同和移民身份对这两种模式均无显著影响。当法医患者入住法医医院时或在其住院的头三天内，临床医生可以评估与隔离和约束相关的指标，从而有效地针对这些需求以减少强制措施的使用。
