Preventing, reducing, and attenuating restraint: A prospective controlled trial of the implementation of peer support in acute psychiatry

Frontiers in Psychiatry

Psychiatry

Felix Bermpohl¹  Julia Badouin²  Andreas Bechdolf³  Stefan Weinmann⁴  Johanna Baumgardt⁵ 

[1]Department of Psychiatry and Neuroscience, Charité Campus Mitte Charité—University Medicine Berlin, Berlin, Germany

[2]Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité–University Medicine Berlin, Berlin, Germany

[3]Department of Psychiatry and Neuroscience, Charité Campus Mitte Charité—University Medicine Berlin, Berlin, Germany

[4]Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité–University Medicine Berlin, Berlin, Germany

[5]ORYGEN, National Centre of Excellence in Youth Mental Health, University of Melbourne, Melbourne, VIC, Australia

[6]Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité–University Medicine Berlin, Berlin, Germany

[7]Psychiatric Hospital, Theodor-Wenzel-Werk, Berlin, Germany

[8]University Psychiatric Clinic (UPK), University Basel, Basel, Switzerland

[9]Department of Psychiatry, Psychotherapy and Psychosomatic Medicine, Vivantes Hospital Am Urban, Vivantes Hospital im Friedrichshain, Academic Hospital, Charité–University Medicine Berlin, Berlin, Germany

[10]Wissenschaftliches Institut der AOK (WIdO), Berlin, Germany

关键词: peer support;    acute psychiatric care;    predictor;    recovery;    restraint;   

DOI  :  10.3389/fpsyt.2023.1089484

 received in 2022-11-04, accepted in 2023-01-20,  发布年份 2023

来源: Frontiers

【 摘 要 】

IntroductionThe use of restraint as a means of managing patients is considered a critical factor that interferes with recovery. Strategies to create a less restrictive environment within psychiatric facilities are therefore eagerly sought. Peer support workers (PSWs) are increasingly employed in mental health settings. The prevailing theory is that PSWs have the potential to contribute to conflict and restraint prevention efforts in acute psychiatric wards. However, to date, research in support of this claim remains limited.ObjectiveThe present study aimed at assessing the effectiveness of employing peer support workers with regard to reducing the use of restraint.MethodsThis prospective controlled pre–post study sought to evaluate the implementation of peer support in one locked ward compared to treatment as usual (TAU) with no implementation of peer support in a second locked ward of a psychiatry department in Berlin, Germany. The pre–post comparison was planned to consist of two assessment periods of 3 months each, taking place directly before and after peer support implementation or TAU. Both assessments were extended to a period of 6 months, before and after the initially planned 12-month implementation process, in order to balance the effects of disruptions and of the COVID-19 pandemic. Using routine data, the proportion, frequency, and duration of mechanical restraint, forced medication as well as mechanical restraint in combination with forced medication, were evaluated.ResultsIn the control group, an increase in the proportion of patients subjected to measures of restraint was found between pre- and post-assessment, which was accompanied by a further increase in the mean number of events of restraint per patient within this group. In the intervention group, no significant change in the application of restraint was observed during the study period.DiscussionThere is some indication that peer support may be protective with regard to restraint in acute wards. However, our study faced major challenges during the implementation process and the post-assessment period, such as COVID-19 and staff reorganization. This may have led to peer support not reaching its full potential. The relationship between the implementation of peer support and the use of restraint therefore merits further investigation.

【 授权许可】

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Copyright © 2023 Badouin, Bechdolf, Bermpohl, Baumgardt and Weinmann.