Measuring Restrictiveness of Psychiatric Care

"Restrictiveness" is neither a narrow legal concept nor a clinical concept that encompasses all aspects of a patient and his treatment; it refers to several features of treatment that can infringe on individual freedoms. As part of a study to develop a reliable method to measure restrictiveness, 31 mental health professionals were asked to rate the restrictiveness of six dimensions of treatment, such as legal status, and 33 treatment alternatives. Interrater reliability was high for both the importance of dimensions (alpha = .92) and the restrictiveness of alternatives within dimensions (alpha = .99). The treatment dimension judged most important in assessing restrictiveness was "limitations of physical freedom." The scale resulting from these judgments offers a plausible measurement of the restrictiveness of treatment configurations for use in evaluation research. The authors caution that restrictiveness is not in itself a comprehensive index of the quality of psychiatric care.