Determinants of mechanical restraint and the role of verbal de-escalation techniques in patients with schizophrenia during involuntary hospital transfer

Mechanical restraint (MR) is a significant ethical and clinical concern in psychiatric care and should be avoided whenever possible. A commonly recommended strategy to avoid MR, which is not yet strongly evidence-based, is verbal de-escalation (VD).

This naturalistic observational study included individuals with schizophrenia who were involuntarily transferred from their homes to the emergency room by a specialized psychiatric home care team between 2008 and 2020. In 2013, the entire team began annual training in VD techniques, following Project BETA guidelines. The study compares MR use before and after the introduction of VD training. It also aims to identify the factors associated with the use of MR during these transfers.

Clinical and sociodemographic characteristics were compared between those who required MR and those who did not. Among 420 transfers included in the study, MR was used in 128 cases (30.5 %), while 292 (69.5 %) were managed without it. After the training, there was a 40 % reduction in MR use.

A multivariate logistic regression analysis identified three significant factors that were associated with MR use: the use of VD, PANSS-Excited Component (PANSS-EC) score (assessed prior to transfer), and age. A PANSS-EC score ≥20 was strongly associated with MR (OR = 4.36, 95 % CI: 2.74–6.95).

These findings suggest that staff training in VD may be associated with reduced MR use during involuntary transfer of patients with schizophrenia.