Legislative differences regarding coercive measures in mental health care for children and adolescents across European countries

Abstract To examine variations in legal and clinical practice regarding coercive measures use in child and adolescent psychiatry. A study commissioned by the European Society for Child and Adolescent Psychiatry (ESCAP) Policy Division in collaboration with ESCAP executive board. A questionnaire was distributed to representatives of 36 ESCAP member countries aiming to obtain an overview of coercive measures used, with a focus on regulation and use of mechanical and physical restraint, and seclusion. The survey received 35 responses, covering 24 countries. Data was analysed to identify common themes and notable differences in legislative approaches. Most participating countries lack legislation specifically tailored for minors regarding coercive measures, applying the same standards as adults. Legal conditions for the use of restraint or seclusion generally emphasise imminent danger to self or others. Only six of the 24 countries set a maximum duration for coercive practices, with re-assessment requirements varying from 15 min for restraints to intervals of up to three weeks for seclusion. The study also reveals ethical concerns around the use of coercive measures and highlights discrepancies between legal frameworks and clinical practice across countries. The findings highlight a need for further discussions on shared guidelines to promote ethical and consistent application of coercive measures for minors in European mental health care.