Introduction
Seclusion and restraint in psychiatry are controversial practices with no evidence-based therapeutic benefit that should only be considered as a last resort according to guidelines. However, their use is insufficiently documented and knowledge on the associated factors is fragmentary worldwide. Taking advantage of a rare standardized nationwide register recently made available in France, our objectives were to document the extent of the use of seclusion and restraint in psychiatry, its variations across hospitals and the associated factors.
Methods
We focused on seclusion and mechanical restraint during an involuntary psychiatric hospitalization in line with the applicable national legislative framework. We estimated the number of measures for adult patients in 2022 in the whole of France, the number and characteristics of patients concerned, and variations in use across hospitals. Based on a conceptual framework drawn from the literature on medical practice variations adapted to those with ethical stakes, multilevel logistic regressions were conducted to identify patient, healthcare provider and contextual characteristics associated with the use of seclusion and restraint in psychiatry.
Results
The availability of a recent national register allows estimating that one third of involuntary hospital stays in psychiatry were associated with seclusion measures, while mechanical restraint concerned 8% of these stays. There were significant variations across hospitals in their use, with some hospitals never resorting to them. While restrictive measures were more commonly used for young male individuals with complex care needs, patient characteristics explained only a limited share of variations across hospitals.
Discussion
A better understanding of the use of restrictive measures in psychiatry is a critical first step to inform effective public policies to reduce this use, as supported by international guidelines. The availability of national registers should be encouraged worldwide.