The influence of a systematic risk assessment and a training course in aggression management on seclusion rates in Switzerland: a multi center study

Background

To explore the influence of a systematic risk assessment and a training course in aggression management on seclusion rates in Switzerland.

Methods

We conducted a multi-center partially randomized controlled trial on 24 acute psychiatric admission wards in the German speaking region of Switzerland. The wards were cluster randomized into 5 study arms (training course, systematic risk assessment, systematic risk assessment and training course combined, control group, preference wards utilizing only the systematic risk assessment). Aggressive incidents and coercive measures (seclusion, involuntary medication, and fixation) were recorded at pre and post intervention.

Results

We recorded 1,256 coercive measures in 81,255 treatment days of the trial. 1,134 coercive measures were administered in conjunction with aggressive behavior. In the preference arm the coercion rates fell from1.432 (95% CI 1.160 – 1.749) to 0.552 (95% CI 0.402 – 0.788) per 100 treatment days. A significant drop in coercion rates per 1000 treatment days were recorded on the wards having introduced the training course (pre test 23.81, 95% CI = 20.98 – 26.93 versus 17.699, 95% CI = 14.908 – 20.865 post test) and on the risk assessment preference wards test (15.811, 95% CI = 12.945 – 19.128 versus 6.265, 95% CI = 4.515 – 8.468). The main reasons for seclusion were the reduction of stimuli (498), treatment refusal (474), danger to others (460), and aggressive behavior (306).

Conclusion

A systematic risk assessment (preference arm) and a training course in aggression management are effective in reducing seclusion in psychiatric acute admission wards. The other two interventions (a systematic risk assessment alone and in combination with a training course) have no influence on seclusion rates. The preference arm wards faired well on the reduction of all coercive measures and seclusion. This finding may point to the possible role of motivation as a key factor in the reduction of coercion.