International variation in containment measures for disturbed psychiatric inpatients: a comparative questionnaire survey

Background Disturbed psychiatric inpatients are managed using a range of containment measures (e.g. seclusion, mechanical restraint) whose use differs by country. Little is known about why these differences exist, or about how staff choose between the different methods available to them. Aims To compare psychiatric professionals attitudes to containment measures between countries with different practices, and to discover what factors have the greatest impact on preparedness to use a containment method. Method Surveys of psychiatric professionals in the United Kingdom, the Netherlands, Finland, and Australia, using the Attitude to Containment Measures Questionnaire. Results Relative approval of different containment measures broadly matched what we know about different practices, with some notable differences. Staff in Finland expressed the highest level of approval of containment, staff in the UK the least, with those in the Netherlands in between. Individuals' preferences for different containment measures were largely determined by whether they considered it (i) safe for the patients undergoing it, (ii) prevented them from injuring others, and (iii) quickly calmed them. Conclusion Future evaluation research on containment measures should use time taken to calm the patient, injury to patients and others, as primary outcomes. National clinical audit and injury reporting systems would also enable the identification of methods that are truly physically injurious to patients, aiding in the rational selection of appropriate containment measures.