Use of the least intrusive coercion at Danish psychiatric wards: A register-based cohort study of 131,632 first and subsequent coercive episodes within 35,812 admissions

• Published in: International journal of law and psychiatry 2022-11, Vol.85, p.101838-101838, Article 101838
• Main Authors: Linkhorst, Thea, Birkeland, Søren Fryd, Gildberg, Frederik Alkier, Mainz, Jan, Torp-Pedersen, Christian, Bøggild, Henrik
• Format: Article
• Language: English
• Subjects: Adult; Coercion; Cohort Studies; Denmark; Female; Hospitals, Psychiatric; Humans; Male; Mental disorders; Mental Disorders - psychology; Mental Disorders - therapy; Psychiatric Department, Hospital; Psychiatry; Restraint, physical; Restraint, Physical - psychology
• ISSN: 0160-2527; 1873-6386
• DOI: 10.1016/j.ijlp.2022.101838

Psychiatric legislation in Denmark implies a principle of using the least intrusive types of coercion first. The intrusiveness is not universally agreed upon. We examined the order in which coercive measures during admission were used, implying that the first used should be less intrusive than the following types. For coercive episodes reported to the national administrative register for the period 2011–16, the order of 12 legal coercive interventions during each admission was examined. Comparing with mechanical restraint, the odds ratio (OR) and confidence interval (95%CI) of being first or subsequent used types were estimated using conditioned (96,611 episodes) and unconditioned (131,632 episodes) logistic regression models, stratified on sex. Totally 17,796 patients aged 18+ were subjected to at least one coercive episode. The median time between admission and the first episode was 4 days in men and 6 for women. For females, involuntary detention, forced feeding, coercive treatment of somatic disorder, locking of doors and close observations in females were used before mechanical restraint, and forced follow-up, involuntary electro convulsive therapy (ECT), forced treatment, use of gloves and straps, physical restraint and forced intramuscular medication was used later. In men, only involuntary detention was used before mechanical restraint, while involuntary ECT, close observations, administration of drugs, use of gloves and straps, physical restraint and forced intramuscular medication was used after mechanical restraint. The order of used coercive measures is not consistent with the international ranking of the least intrusive types, especially in men and in younger adults. •The order of coercive types is not consistent with the ranking of intrusiveness proposed by international literature.•Especially mechanical restraint is used among the first episodes compared to physical restraint and forced intramuscular medication.•In men, only involuntary detention is used earlier than mechanical restraint.•The order is recorded by day only, so it is not possible to distinguish between closely initiated episodes.•The data used for this analysis was collected for administrative purposes.