Admission to an inpatient Child and Adolescent Mental Health Service (CAMHS) can be a distressing experience for children and young people. This typically happens as a last resort when community-based options have been exhausted.
CAMHS services cater to individuals facing serious mental health challenges that significantly impact their well-being. These may include suicidal tendencies, safety threats, aggression, eating disorders, and more. There’s a growing concern over lengthy wait times for support, leading to more young individuals reaching a mental health crisis before receiving help.
Coercive interventions like mechanical, physical, or chemical restraint, seclusion, and forced tube feeding are sometimes used in response to extreme distress, self-harm, or violence. However, these practices can have negative psychological and physical effects, potentially worsening mental health conditions. Recognizing coercion as a violation of human rights, policymakers globally aim to minimize or eliminate the use of such practices in inpatient settings, with a focus on children and young people.
A recent study by Moell et al. (2024) aimed to systematically review the rates and risk factors of coercive measures in inpatient CAMHS to provide insights for improving care practices.
Policy makers internationally have set out an ambition to reduce or eliminate the use of restrictive practices across inpatient settings with children and young people a priority.
Methods
The study conducted a systematic review to analyze the incidence, prevalence, and risk factors of coercive measures in CAMHS inpatient care. Various databases were searched for relevant studies from 2010 to 2024, and quantitative data were extracted for analysis.
Findings from 30 studies, involving a total of 39,027 patients, highlighted varying rates of coercive measures. Factors such as patient demographics, unit specialization, and care-related aspects influenced the use of coercion.
This systematic review suggests that coercive measure use and risk factors in inpatient CAMHS vary substantially across settings.
Results
- The median prevalence of any coercive measure was 17.5%, with varying rates for restraint and seclusion.
- Demographic factors, unit type, and patient behaviors influenced the use of coercive measures.
- Younger age, male gender, non-White ethnicity, and aggression were common predictors of coercion.
- Extended hospital stays and multiple admissions were associated with a higher likelihood of coercive measure exposure.
- Significant variations were observed across different CAMHS settings regarding coercive practices.
Conclusions
The study authors emphasized the need to reduce reliance on coercive interventions in child and adolescent mental health settings. They called for further research to understand and mitigate the use of such measures, considering both patient and care-related factors.
Efforts to standardize definitions, measurements, and outcome assessments related to coercive practices are crucial for future studies and improvements in care practices.
Repeated concerns that young women who self-harm experience disturbing levels of coercion surprisingly doesn’t seem to be a feature in the included literature.
Implications for Practice
While coercion may sometimes be necessary in extreme situations, minimizing its use should be a priority in child and adolescent mental health care. Understanding the factors influencing coercion and implementing interventions to reduce its occurrence are essential for providing a safe and supportive environment for young individuals.
Research on behavior change techniques and interventions to reduce coercive practices in institutional settings shows promise, emphasizing the importance of staff training, environmental restructuring, and outcome feedback.
The use of coercive practices in children should be avoided, and we are building a better understanding of the behavior change interventions that can aid its reduction.
Links
Primary Paper
Astrid Moell, Maria Smitmanis Lyle, Alexander Rozental, Niklas Långström (2024). Rates and risk factors of coercive measure use in inpatient child and adolescent mental health services: a systematic review and narrative synthesis. The Lancet Psychiatry. https://doi.org/10.1016/S2215-0366(24)00204-9.
Other References
Baker J, Kendal S, Berzins K, Canvin K, Branthonne-Foster S, McDougall T, Goldson B, Kellar I, Wright J, Duxbury J (2022). Mapping Review of Interventions to Reduce the Use of Restrictive Practices in Children and Young People’s Institutional Settings: The CONTRAST Study. Children and Society: the International Journal of Childhood and Children’s Services, 36(6).
Nawaz RF, Reen G, Bloodworth N, Maughan D, Vincent C. (2021). Interventions to reduce self-harm on in-patient wards: a systematic review. BJPsych Open, 7(3), e80. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8086389/.
