Prevalence and Predictors of Mechanical Restraint in Involuntary Patients in an Open-Door Inpatient Psychiatric Unit

PurposeMechanical restraint (MR) remains one of the most controversial interventions in psychiatry, particularly in involuntarily admitted patients. This study examined the prevalence and clinical predictors of MR in an open-door psychiatric unit in Spain, a context where national MR rates remain among the highest in Europe. MethodsA retrospective descriptive study of all involuntarily admitted patients (n = 81) was conducted in a 20-bed open-door acute psychiatric unit between June and December 2024. Sociodemographic, diagnostic, and treatment variables were extracted from electronic health records. Bivariate analyses and multivariate logistic regression were used to identify independent predictors of MR. ResultsMR was applied in 14.8% of patients, representing a approximately 60% reduction compared with the Spanish national average of 37% reported in multicentre European data. In multivariate analysis, schizophrenia spectrum disorder was the strongest independent predictor (OR = 12.29, 95% CI: 1.75-86.46, p = 0.012). Male gender showed a significant bivariate association but lost significance after adjustment. MR co-occurred with intramuscular psychotropic medication in 91.7% of cases. ConclusionsEven within a high-risk, 100% involuntary population, open-door policies combined with structured de-escalation interventions can substantially reduce MR use. Schizophrenia spectrum disorders emerge as a critical target for prevention strategies. These findings align with convergent evidence from German, Swiss, and Norwegian studies supporting the safety and effectiveness of open-door approaches, and provide the first Spanish data on MR in this model of care.