Impact of legislative reform on coercive measure use in child and adolescent psychiatry: A controlled interrupted time series analysis

Abstract

Evidence on legislative reforms to reduce coercive measures remains limited. We evaluated short-to-medium-term effects of Sweden’s July 2020 stricter legal regulation of coercive measures in youth < 18 years. In a controlled interrupted time-series study, we used 2017–2021 registry and electronic medical record data from inpatient child and adolescent mental health services (CAMHS) in Region Stockholm, Sweden. Controls included Finnish CAMHS and Region Stockholm young adult psychiatric patients (18–24 years). Monthly outcomes were rates of seclusion, mechanical restraint, involuntary medication and a composite measure, mean durations, and sedative medication use. Segmented regression estimated level- and trend changes, adjusting for pre-intervention trends. Among 7,075 admissions (3,840 individuals) to Stockholm inpatient CAMHS, involuntary medication increased immediately in minors relative to young adults (incidence rate ratio 2.49, 95% CI 1.63–3.81), with no other changes in patient-day-standardised models. Comparisons with Finnish CAHMS provided no consistent evidence of reduced coercion. Mean durations also increased in minors versus young adults (12% for seclusion; 6% for mechanical restraint), while sedative medication use remained stable. Findings were robust in sensitivity analyses. Contrary to the reform’s aims, stricter legislation alone was not associated with reduced coercive measure use.