In a study published in Epidemiology and Psychiatric Sciences, an international team of researchers reports wide variation in the use of mechanical restraint in psychiatric care across four Pacific Rim countries. Mechanical restraint is the use of a device to restrict patient movement. Considered inconsistent with human rights treaties, all four countries have policies intended to minimize its use.
The author of several large-scale studies of psychiatric inpatient safety, Vincent Staggs, PhD, Director of the Biostatistics and Epidemiology Core at Children’s Mercy-Kansas City, was invited to join a team of researchers from universities in New Zealand, Japan, and Australia to compare rates of mechanical restraint across their respective countries using publicly available data. Unlike hospitals in the other three countries, U.S. hospitals report total time spent by patients in restraints each year but not the number of restraint events. To allow for comparison across countries, the team used data from one of Dr. Staggs’ previous studies to estimate the average duration of restraint in the U.S. From this they estimated hospitals’ total count of restraint episodes each year, and these counts were used to compute total restraint events per million population per day.
In 2017, rates varied from 0.03 (New Zealand) to 98.9 (Japan) restraint events per million population per day, over a 3,000-fold difference. Rates in Australia (0.17) and the U.S. (0.37) fell between these two extremes. There was also substantial variation in restraint rates within each country. No steady reduction in restraint was observed in any country during the period for which data were available (2003 at the earliest).
Mechanical restraint is controversial and poorly regulated. It is also not well-studied, particularly in the pediatric population.
“This study is an example of the far-reaching impact Children’s Mercy researchers have on global health,” Staggs said. “When we see wide variation in health care quality or safety across institutions or regions, we know there is room for improvement. Psychiatric inpatients are a vulnerable population, and researchers have paid too little attention to whether policies intended to reduce or eliminate use of mechanical restraint are working. We want to change that.”
Besides his work at Children’s Mercy, Dr. Staggs is also an Associate Professor in the University of Missouri-Kansas City School of Medicine.