Can physical activities reduce the use of
coercive measures?
Anne Næsted and Lene Berring
Region Zealand Psychiatry, Denmark
Background
20 % of the patients submitted
to a psychiatric hospital are involved in some form of coercion.
Various national measures have
been implemented but only
with sporadically effect. From
2012-2014 was launched a
­national project in which physical activity was the main intervention in our efforts to reduce
coercion.
Method
Curiosity, openness and recipro­
city were characteristic for the
beneficial collaboration in the
network.
Six teams located in different areas of the Region Zealand, were established. The
teams covered all fields of the
psychiatry.
One implementation team
­supervised the teams.
A service user panel (n=12)
­supervised the process.
All teams-participants were
­educated in the ‘Break-Through
Method and how to initiate
physical activities.
All patients at the involved units
were included in the project.
Data about coercive measures
was registered.
Result
Aim
The aim was to reduce the use
of coercive measures by implementing physical activities during hospitalization. Our
­hypothesis was that through
physical activities, staff and
patients would achieve a better relationship with each other, and that patients would experience more comfort and less
aggression.
#Restraining straps
# Mechanical restraint# Physical restraint # Medical restraint #Restraining straps
400
350
300
# Total sum
250
Values
200
# Mechanical restraint
# Physical restraint
# Medical restraint
150
Coercive measures remained
unchanged, at region level.
However, we saw improvement
at unit level, with different local
changes. One unit had success
with a combination of physical
activity and a strong leadership
who facilitated reviews.
Physical activities became a part
of the patient’s treatment plan.
Culture changed toward a less
restrictive environment, and
became a more patient inclusive approach. The ‘network’
developed a joint understanding of each other’s activities
and learned from each other,
which led to a more motivating, inspiring and collaborative
community.
#Restraining straps
100
The Graph shows the sum of four different coercive measures for a three year
period (2012 - 2014):
Mechanical restraint, Physical restraint (hold­
ing) medical restraint (rapid tranquilization)
and ‘arms and feets’ restraining straps.
50
0
1
2
3
4
5
6
7
8
2012
9
10 11 12
1
2
3
4
5
6
7
8
9
10 11 12
1
2
3
2013
4
5
6
7
8
9
10 11 12
2014
Time
År
Måned
Conclusion and implication for the future
involved units reported that
the project and the work
in the network influenced
the culture in the units toward an environment with
an increased level of patient
involvement.
Replacing the use of coercive measures with
less restrictive ­methods
is a long-term s
­ trategy.
Based on results from the
implemen­tations project we are strengthening the s
­ trategies by raising an awareness of the
10 interventions from
Safewards and the Six Core
Strategies©, which emphasize the importance of a
strong leadership.
Design & illustration: Karina Bjerregaard
Physical activity did not
affect the use of coercive
­measures to such an extent,
that it was possible to see
a decline in the statistics
at a regional level. All the