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. 2024 Jan 11;10(1):e26.
doi: 10.1192/bjo.2023.613.

Comparison of coercive practices in worldwide mental healthcare: overcoming difficulties resulting from variations in monitoring strategies

Martha K Savage  1 , Peter Lepping  2 , Giles Newton-Howes  3 , Richard Arnold  4 , Vincent S Staggs  5 , Steven Kisely  6 , Toshio Hasegawa  7 , Keith S Reid  8 , Eric O Noorthoorn  9
Affiliations

Comparison of coercive practices in worldwide mental healthcare: overcoming difficulties resulting from variations in monitoring strategies

Martha K Savage et al. BJPsych Open. .

Abstract

Background: Coercive or restrictive practices such as compulsory admission, involuntary medication, seclusion and restraint impinge on individual autonomy. International consensus mandates reduction or elimination of restrictive practices in mental healthcare. To achieve this requires knowledge of the extent of these practices.

Aims: We determined rates of coercive practices and compared them across countries.

Method: We identified nine country- or region-wide data-sets of rates and durations of restrictive practices in Australia, England, Germany, Ireland, Japan, New Zealand, The Netherlands, the USA and Wales. We compared the data-sets with each other and with mental healthcare indicators in World Health Organization and Organisation for Economic Cooperation and Development reports.

Results: The types and definitions of reported coercive practices varied considerably. Reported rates were highly variable, poorly reported and tracked using a diverse array of measures. However, we were able to combine duration measures to examine numbers of restrictive practices per year per 100 000 population for each country. The rates and durations of seclusion and restraint differed by factors of more than 100 between countries, with Japan showing a particularly high number of restraints.

Conclusions: We recommend a common set of international measures, so that finer comparisons within and between countries can be made, and monitoring of trends to see whether alternatives to restraint are successful. These measurements should include information about the total numbers, durations and rates of coercive measures. We urge the World Health Organization to include these measures in their Mental Health Atlas.

Keywords: Epidemiology; consent and capacity; ethics; human rights; in-patient treatment.

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Conflict of interest statement

G.N.-H. and S.K. are psychiatrists and in the course of clinical work may encounter situations where RPI is requested and currently in force. K.S.R. is a forensic psychiatrist, policy author and National Health Service commissioner and has had patient representational roles. S.K. is a member of the international editorial board of BJPsych and the editorial board of BJPsych International. M.K.S.'s son died after being mechanically restrained to his bed continuously for 10 days in a psychiatric hospital in Japan. She is a member of the WPA's Working Groups on developing partnerships with service users and family carers; implementing alternatives to coercion in mental healthcare; and volunteering. V.S.S. has served as an expert consultant/witness in lawsuits regarding staff safety at psychiatric facilities.

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