Organisation av och statistik om tvångsvården i Finland

1. Organisation av och statistik om tvångsvården i Finland Lauri Kuosmanen RN, PhD, Adjunctprofessor

3. * Erikoissairaanhoidon avohoidon tietoja on kerätty vuodesta 1998 alkaen, mutta vertailukelpoisia luvut ovat vuodesta 2006 alkaen. Lähde: Psykiatrinen erikoissairaanhoito. THL Tilastoraportti 4/2013

4. Psykiatrisen erikoissairaanhoidon laitoshoidon hoitojaksot ja hoitojaksojen potilaat sairaanhoitopiireittäin vuonna 2011, epäsuora ikä- ja sukupuolivakiointi, koko maa=100 Lähde: Psykiatrinen erikoissairaanhoito. THL Tilastoraportti 4/2013

6. KIITOS!

8. KIITOS!

9. KIITOS!

10. Coercive measures in Finland 2006-2012

11. *2012 ennakkotietoa Lähde: Psykiatrinen erikoissairaanhoito. THL Tilastoraportti 4/2013

12. Jyväskylä, Finland Lainattu: Jani Korpela; KSSHP

13. EKSOTE, mental health services, Finland Lainattu: Timo Salmisaari

16. Activities 2012-2013 • Facebook • Web pages • Two national meetings • 1st in halikko Hospital (60 participants) • 2nd in EKSOTE (160 participants) • Less than 10% of participants service users • Halikko statement to stop the use of mechanical restraints in Finland by year 2020

18. Future • One national meeting per year • Funding 0 € • Funding for service users from NFSMH and other sources! • Facebook • Integration to another working group on the same topic (National Institute for Health and Welfare [THL] & Finnish Hospital Districts) in November 2014

21. Kiitos! lauri.kuosmanen@utu.fi +358 40 5741005

22. Mental health research in Finland • Epidemiological nationwide studies • Use of national database • University led ”focused” studies • Increasing interest on research related to coercion in psychiatry

23. SAKURA Study • Started as comparative study between Japan and Finland • 3 large psych hospitals in Helsinki area • Aim was to compare attitudes, and use of seclusion and restraint (Soininen et al. 2010) • Comparison was deemed to be impossible due to major cultural differences • In Japan mean time in seclusion is over 1000h • Most common reason for use of S/R in Japan is ”to prevent patient causing shame to family or herself”

24. Decision making involved in use of seclusion and restraint (Laiho et al. 2013, Laiho 2009) • Complex phenomena • No archetypal situations for use of S/R • Except actual violence • Patient and personnell related factors are equal in decision • Culture? • Attitudes?

26. Culture and attitudes? • What is ward culture? • Poorly defined concept • ”Common way of doing things” • Attitudal culture doesn’t exist (Laiho et al. Submitted) • Opinions (on aggression) are individual • Attitudal culture exists if nurses on shift think alike • Only ”seeing aggression as way to protect oneself or own space” seems to be related to ward

27. Assessment • Assessing secluded ofr restrained patient (Sailas et al. In process) • Observed harmful behaviour increased in 4 hours • Staff’s ”intuition” on patients future harmful behaviour doesn’t change during S/R episode • When comparing assessments between nurses, similar finding was done than in aggression study • When nurses assess patient, they assess something in themselves?

31. Cluster-Randomized Controlled Trial of Reducing Seclusion and Restraint in Secured Care of Men With Schizophrenia.Anu Putkonen, Satu Kuivalainen, Olavi Louheranta, Eila Repo-Tiihonen, Olli-Pekka Ryynänen, Hannu Kautiainen, Jari TiihonenPsychiatric services ABSTRACT OBJECTIVE This randomized controlled trial studied whether seclusion and restraint could be prevented in the psychiatric care of persons with schizophrenia without an increase of violence. METHODS Over the course of a year, 13 wards of a secured national psychiatric hospital in Finland received information about seclusion and restraint prevention. Four high-security wards (N=88 beds) for men with psychotic illness were then stratified by coercion rates and randomly assigned to two equal groups. In the intervention wards, staff, patients, and doctors were trained for six months in applying six core strategies to prevent seclusion-restraint; six months of supervised intervention followed. Poisson's regression analyses compared monthly incidence rate ratios (IRRs) of coercion and violence (per 100 patient-days). RESULTS The proportion of patient-days with seclusion, restraint, or room observation declined from 30% to 15% for intervention wards (IRR=.88, 95% confidence interval [CI]=.86-.90, p<.001) versus from 25% to 19% for control wards (IRR=.97, CI=.93-1.01, p=.056). Seclusion-restraint time decreased from 110 to 56 hours per 100 patient-days for intervention wards (IRR=.85, CI=.78-.92, p<.001) but increased from 133 to 150 hours for control wards (IRR=1.09, CI=.94-1.25, p=.24). Incidence of violence decreased from 1.1% to .4% for the intervention wards and from .1% to .0% for control wards. Between-groups differences were significant for seclusion-restraint-observation days (p=.001) and seclusion-restraint time (p=.001) but not for violence (p=.91). CONCLUSIONS Seclusion and restraint were prevented without an increase of violence in wards for men with schizophrenia and violent behavior. A similar reduction may also be feasible under less extreme circumstances.

32. eLearning course may shorten the duration of mechanical restraint among psychiatric inpatients: A cluster-randomized trialRaija Kontio , Anneli Pitkänen , Grigori Joffe , Jouko Katajisto , Maritta VälimäkiNordic Journal of Psychiatry, 2013, Early Online Background: The management of psychiatric inpatients exhibiting severely disturbed and aggressive behaviour is an important educational topic. Well structured, IT-based educational programmes (eLearning) often ensure quality and may make training more affordable and accessible. Aims: The aim of this study was to explore the impact of an eLearning course for personnel on the rates and duration of seclusion and mechanical restraint among psychiatric inpatients. Methods: In a cluster-randomized intervention trial, the nursing personnel on 10 wards were randomly assigned to eLearning (intervention) or training-as-usual (control) groups. The eLearning course comprised six modules with specific topics (legal and ethical issues, behaviour-related factors, therapeutic relationship and self-awareness, teamwork and integrating knowledge with practice) and specific learning methods. The rates (incidents per 1000 occupied bed days) and durations of the coercion incidents were examined before and after the course. Results: A total of 1283 coercion incidents (1143 seclusions [89%] and 140 incidents involving the use of mechanical restraints [11%]) were recorded on the study wards during the data collection period. On the intervention wards, there were no statistically significant changes in the rates of seclusion and mechanical restraint. However, the duration of incidents involving mechanical restraints shortened from 36.0 to 4.0 h (median) (P < 0.001). No statistically significant changes occurred on the control wards. Conclusions: After our eLearning course, the duration of incidents involving the use of mechanical restraints decreased. However, more studies are needed to ensure that the content of the course focuses on the most important factors associated with the seclusion-related elements. The eLearning course deserves further development and further studies. The duration of coercion incidents merits attention in future research.