2021 Volume 33 Issue 1 Pages 57-64
BACKGROUND: The actual situation regarding the use of seclusion and restraints in Japanese psychiatric hospitals remains mostly elusive. OBJECTIVE: To elucidate the characteristics of patients who have been subjected to seclusion and restraints and the reasons for the use and duration of the techniques performed under clinical contexts. METHODS: A comprehensive review of electronic health records at a single-center stand-alone psychiatric hospital was performed, investigating the content of seclusion and restraint orders initiated between October 2018 and September 2019. RESULTS: A total of 1389 orders of restrictive measures were reviewed, resulting in 1083 orders (390 seclusions, 693 restraints) for final analysis. These orders corresponded to 363 patients, with nearly half diagnosed with schizophrenia (n=177, 49%) and the next most frequent diagnosis being dementia (n=53, 15%). Reasons for seclusion included "worrisome course," "self-harm," and "excitement and agitation," while "falls and wandering" and "medical treatment" were typically selected as reasons for restraint orders. The number of restrictive measures ordered per patient was three on average and 41 at maximum. The total duration of restrictive measures performed per patient was 213 (92–569) hours in the median and interquartile ranges, with the maximum being 8478 hours. CONCLUSION: It was a notable finding that restraints were administered for less than 24 hours in nearly half of the patients. The ethical legitimacy of the duration in which restrictive measures were in place was demonstrated.
