This cluster-randomized controlled
trial has demonstrated that in providing
care for patients with schizophrenia
and a history of violent
behavior, it is possible to prevent the
use of coercive measures without an
increase in violence. Both the proportion
of patient-days when any
coercion was used and the time spent
in seclusion-restraint decreased significantly
more in the intervention
wards than in the control wards,
without an increase in violence. Contrary
to fears and expectations that
had sustained the coercive culture,
the severity of patient-to-patient injuries
(including self-mutilation) did not
increase, and in fact severity decreased
in the intervention wards.
Injuries to staff remained minor.