Physical Restraints in the Emergency Department and Attendance at Subsequent Outpatient Psychiatric Treatment

While an estimated 8.5% of psychiatric patients treated in emergency departments require physical restraint, the impact of restraint on attendance at post-discharge outpatient psychiatric appointments has not been investigated. This study evaluated two groups of patients aged 18 or over: 1) 67 individuals who presented voluntarily or involuntarily (being brought in by the police) to the emergency department and who were physically restrained in the course of clinical care, and 2) a comparative group of 84 individuals who presented involuntarily but were not restrained. Perception of quality of care, recollection of the restraint episode, and attendance at follow-up outpatient appointments were compared between these two groups. Of the 151 patients, 33% were from minorities, 45% were female, and the median age was 36 years (range of 18 to 77 years). Both minority race and use of physical restraints were related to less frequent attendance at the prescribed outpatient psychiatric appointment, based on multivariate logistic regression (odds ratios of 0.40 and 0.38, respectively). Although physical restraint may sometimes be necessary to manage aggression and agitation in the emergency department, being restrained appears to be associated with decreased likelihood of attending prescribed outpatient follow-up mental health treatment. Clinicians should consider alternatives to physical restraints whenever possible to minimize impact on treatment compliance after discharge from the emergency department. (Journal of Psychiatric Practice 2011; 17: 387-393)