The use of coercive practices in inpatient psychiatric facilities has been an issue of debate since the deinstitutionalization of psychiatric services. Global reports claim that the use of coercive measures has decreased, but it is unclear if these practices have truly changed over time.

In  BMC Psychiatry, professor of nursing science at the University of Turku Maritta Välimäki, PhD, professor at the West China Research Center for Rural Health Development Min Yang, MD, MPH,  biostatistician at the University of Turku Tero Vahlberg, PhD, postdoctoral researcher at the University of Turku Tella Lantta, PhD, university teacher at the University of Turku Virve Pekurinen, PhD, senior researcher at the University of Turku Minna Anttila, and S. James Adelstein Professor of Health Care Policy (Biostatistics) Sharon-Lise Normand, PhD, investigate the use of coercive measures in Finnish psychiatric hospital units. The study defines coercive measures as seclusion, limb restraints, forced injection, and physical restraints.

Over a 20-year period, the study found that the prevalence of coercive treatment on inpatients was 9.8%. Seclusion was the most widely used coercive measure, while only the use of limb restraints showed a downward trend over time. 11% of male patients experienced coercive practices, while prevalence among female patients was 8%. Seclusion and limb restraints were used more on male patients, while females had a higher prevalence of forced injection.

Southern Finland had the highest rates of coercive practices, although 50% of patients were treated by providers in that region. Throughout the country there has been a decline in the number of patients admitted to psychiatric hospital, however the number of coerced patients does not mirror this recession.

Explanations that may justify the use of coercive practices such as understaffed hospitals are inadequate, as Finland has one of the highest staff to patient ratios in the world. As the decision to use coercive treatment is currently based on clinical judgement, the authors suggest the implementation of national clinical guidelines that give recommendations based on evidence gathered from past interventions.

The study found that despite reports, the reduction in coercive measures in Finnish psychiatric hospitals has been small over the last two decades. Future development of structured guidelines and effective management of challenging situations should heed these results. The authors suggest critical assessment of clinical guidelines and staff education to ensure ethical competency of psychiatric hospital staff who interact with vulnerable patient populations.