Demographic and Clinical Characteristics Impact the Use of Restrictive Interventions in an Adolescent Inpatient Unit

ABSTRACT

In adolescents admitted to mental health inpatient units, restrictive interventions are associated with a risk of physical and psychological harm. Mental health policy and legal frameworks advocate least restrictive options and there is a drive to reduce the use of restrictive interventions in inpatient units. There is insufficient evidence pertaining to the characteristics of UK adolescents who are at risk of experiencing restrictive interventions within general adolescent mental health units. This study aimed to determine whether demographic and clinical characteristics are associated with the use and type of restrictive interventions. A retrospective cohort study was conducted using routinely collected data from a general adolescent unit in the National Health Service (NHS) in England, UK, over a 2-year periodbetween 01/01/2021 and 31/12/2022. There were three key findings. Of the 122 adolescents admitted, 46(38%) experienced restrictive intervention. Characteristics associated with the increased use of restrictive interventions included diagnosis of behavioral and emotional disorders and being a child looked after by the local authority. Being male was significantly associated with seclusion and being a child looked after was significantly associated with the use of physical and chemical interventions. These findings have important implications for policy and practice; they highlight the need for careful consideration by professionals, as to whether the risks of admission including the increased risk of restrictive interventions outweigh the potential benefits and for further consideration of the most appropriate strategies for reducing the need for and use of restrictive interventions.

Acknowledgments

This project was conducted through the Structured Operational Research and Training Initiative (SORT IT), a global partnership led by the Special Programme for Research and Training in Tropical Diseases at the World Health Organization (WHO/TDR). The training is based on a course developed jointly by the International Union Against Tuberculosis and Lung Disease (The Union) and Medécins sans Frontières (MSF). This specific SORT IT program was run by Cheshire and Wirral Partnership (CWP) NHS Foundation Trust as part of routine work. Mentorship and the coordination/facilitation of these SORT IT workshops were provided through the CWP NHS Foundation Trust; The Centre for Operational Research, The Union, Paris, France; The Institute of Medicine, University of Chester, UK; and College of Life and Environmental Science, University of Exeter, UK. The SORT IT course that enabled this project was funded by CWP NHS Foundation Trust. The project itself did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Disclosure statement

No potential conflict of interest was reported by the author(s).