Coercive measures in Spanish psychiatric units (EUNOMIA-study)

Background

To present legal regulations of coercive treatments in Spain and to compare the differences between two of these measures: rates of voluntary and involuntary admissions and restraint protocols used in the psychiatric units of general hospitals across different regions in Spain.

Methods

Information was gathered by means of a detailed questionnaire which was sent to the health authorities of the seventeen Spanish sanitary regions concerning about administrative or clinical criteria of the assessment and decision process of compulsory admission.

Results

We have collected data of 23 centers from nine sanitary regions of Spain. Total frequencies of admissions and compulsory admission rates vary remarkably across different regions. Concerning mechanical restraint there is not any legal framework for its implementation and local committees in each center rule the procedure. The main reason for their implementation was "to avoid danger for the patient himself or for others" (48%). Indication of the order was mainly given by the psychiatrists (64.3%) and the range of duration of the measure varied between 8 and 72 hours.

Conclusion

The results showed different patterns in the use of two measures of coercive treatments across different regions in Spain. For future research in the use of coercive treatments it would be necessary to establish a common legal regulation for the application of coercive measures in routine psychiatric care and standardized methods to register these measures in order to gather enough information for a reliable analysis which will be the first step to make a standard of best clinical practice for the use of coercive measures.