精神保健福祉資料(630調査)を用いた隔離・身体拘束施行者数の分析

Analysis of the Use of Seclusion/Restraint Using National Data on Psychiatric Health and Welfare

抄録

　精神保健福祉資料によると，身体拘束は毎年の増加を認め，隔離は2007年に減少に転じたものの2003年に比して高い値である。隔離・身体拘束施行の現状，および身体拘束の施行と関連する要因を明らかにするために，精神保健福祉資料の都道府県別5年間のデータを用いて分析を行った。その結果，隔離多用と身体拘束多用の地域があることがわかった。また人口当たりの身体拘束施行者数は，老人性認知症疾患治療病棟の整備率との関連を認めた。そして身体拘束施行者数の増加は都道府県によって一様ではなかった。精神科病院での認知症患者の入院が，今後さらに増加することが予想されている中，身体拘束施行者数が増加する可能性が考えられた。

　According to national mental health and welfare data, the number of restrained patients in psychiatric inpatient settings increases every year, and the number of secluded patients has been high compared to 2003 though it decreased once, in 2007. The aim of this study is to clarify the present status of the use of seclusion and restraint and investigate the factors causing the continued increase in the use of restraint. National data from all 47 prefectures covering 2003 to 2007 were analyzed. The results demonstrated that prefectural tendencies are homogeneous among neighboring prefectures：one region emerged where seclusion was likely to be applied and another region where restraint were more commonly applied. Moreover, the number of restrained patients per prefecture population was positively linked to the number of beds at geriatric dementia wards operating under the national inclusive payment system. In fact, the level of increase in the use of restraint varied among prefectures. Considering the increasing number of people with dementia in Japan, it is anticipated that the number of restrained patients in psychiatric inpatient settings will continue to increase.