Health

Children with eating disorders twice as likely to be restrained in psychiatric unit

Researchers analysed 500 patient records at Linn Dara, an inpatient unit at Cherry Orchard Hospital

Linn Dara is a 24-bed inpatient psychiatric unit with two high-dependency beds and eight specialist eating disorder beds. Photograph: Google Street View

Seán McCárthaigh
Tue Feb 28 2023 - 10:24

Children and teenagers with eating disorders were more than twice as likely to be physically restrained than other patients during their stay at one of Ireland’s largest psychiatric units, according to the findings of a new medical study.

The research found 38 per cent of young people with an eating disorder attending the Linn Dara inpatient unit at Cherry Orchard Hospital in Ballyfermot between 2018 and 2021 had been subject to physical restraint on at least one occasion compared to 14 per cent of those with a non-eating disorder.

The study revealed that 18 per cent of all admissions to the unit over the four-year period were physically restrained at least once, while 6 per cent had been left in “seclusion” on at least once occasion. This involved being left alone in a room from which they were physically prevented from leaving.

It also established that young people diagnosed with psychosis had the highest prevalence of being subject to seclusion.

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The authors of the study said identifying young people who were at risk of requiring restrictive interventions might allow “early and targeted intervention and prevention”.

They added: “This study suggests that children at risk of restrictive interventions may be identified on admission which could aid in individual care planning, undertaking structured risk assessments and then managing staff levels appropriately.”

The average duration of each episode of physical restraint was 8.65 minutes, while the average episode of seclusion lasted 8 hours and 18 minutes.

A team of researchers analysed the records of almost 500 patients admitted between 2018 and 2021 to Linn Dara – a 24-bed inpatient psychiatric unit with two high-dependency beds and eight specialist eating disorder beds run and funded by the HSE.

The average age of patients was 15.3 years, while almost two-thirds of all admissions were female.

Over 70 per cent of patients were on first admissions, while over 90 per cent were voluntary patients.

The average length of stay was just under 48 days, although the majority of patients were in the unit for less than 30 days.

Figures published by the Mental Health Commission show the Linn Dara unit had the highest number of physical restraints recorded in any child or adult approved centre in Ireland in 2020 with 601 incidents which it attributed to a small number of residents being restrained on a frequent basis.

The study found there were a total of 1,868 episodes of physical restraint among 88 patients between 2018 and 2021 with 186 incidents of seclusion among 29 patients.

Five patients accounted for two-thirds of all seclusions, while five patients also accounted for 57 per cent of all incidents of physical restraint. The majority of such patients had stays of over four months in Linn Dara and had been previously hospitalised.

According to the results, 21 young people had to be physically restrained on 10 or more occasions during their stay in Linn Dara, while six patients had to be secluded at least 10 times.

The study acknowledged that the use of physical restraints and seclusion may be necessary to protect service users and staff from harm as well as being used as a last resort to facilitate the treatment of eating disorders.

However, it also recognised that the use of restrictive interventions can lead to psychological trauma and physical injuries.

The authors said the purpose of their research was to examine the prevalence and frequency of physical restraints and seclusion in a child and adolescent mental health setting in the Republic and to identify any associated demographic and clinical characteristics.

They found that the age, gender and ethnicity of the patients were not significant factors in identifying those who were subject to restrictive interventions.

However, the study said unemployment, prior hospitalisation, involuntary legal status and longer lengths of stay were significantly associated with higher rates of physical restraints and seclusion among patients with non-eating disorders.

Unemployed youths were four times more likely to be secluded than students but there was no significant difference between the two groups in rates of physical restraint.

Researchers said the findings of their study, which are published in the Irish Journal of Medical Science, showed the highest prevalence of physical restraints was among patients with a diagnosis of an eating disorder.

They said the trend might be explained by patients with eating disorders receiving treatment which could include nasogastric feeding.

“If a patient is refusing this treatment, physical restraint may be required as a last resort to facilitate this potentially life-saving treatment,” the study explained.

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