Prevalence of the use of chemical restraint in the management of challenging behaviours associated with adult mental health conditions: A meta-synthesis

INTRODUCTION: Chemical restraint is used to manage uncontrolled aggression, agitation, or violent behaviours of consumers with mental health disorders admitted to acute psychiatric or emergency settings. AIM: This systematic review aimed to synthesise the international prevalence of chemical restraint for non-consenting adults. METHOD: PsychINFO, CINAHL, MEDLINE/PubMed and Google Scholar databses were searched for peer-reviewed literature published between January 1996 and July 2018. This paper reports on data extracted from retrospective audits of chemical restraint practice. RESULTS: 48 papers were included. The median prevalence of use of any restraint was 21.2% (25th% 8.0 to 75th% 36.3). Median prevalence of people who were chemically restrained, of all people restrained in any manner, was 43.1% (25th% 22.9% to 75th% 70.7%). Of all people admitted to facility(ies), the median prevalence of chemical restraint was 7.4% (25th% 2.7 to 75th% 17.6). There was no statistically-significant difference in any prevalence measure considering healthcare setting or country. There was a significant decrease over the review period in the use of any restraint, including chemical restraint. DISCUSSION AND IMPLICATIONS FOR PRACTICE: This is first known comprehensive meta-view of chemical restraint use worldwide, highlighting the need for standardised data collection to enable comparisons between healthcare settings and countries. RELEVANCE STATEMENT: There is an international imperative to reduce or eliminate the use of coercive practices, such as physical and chemical restraint, in mental health care. This study provides important information for mental health nursing by synthesising the international prevalence of chemical restraint for non-consenting adults. This meta-view of the worldwide use of chemical restraint can inform ongoing efforts to reduce its use.