BackgroundWith all the legislative changes (patients’ rights law, decisions of the German constitutional court on forces medication) taking place at the moment, Advance Care Planning and medical treatment agreement are becoming particularly topical.At the Clinics of Upper Bavaria representatives of the clinics, the organised relatives and those affected developed the pilot project «medical treatment agreement» in a trialogical process.Aimto test and enhance the processes associated with the medical treatment agreementto identify and define the target group of patientsto reduce coercive actions, compulsory hospizalisation and to promote voluntary treatmentMethodsThe pilot project has been designed as a learning project. The model project is supervised by a trialogical steering committee.The result and quality control within the pilot project will be performed by means of qualitative evaluation.Resultsa practical example of a trialogical (psychiatric acute care hospital, relatives and those affected) implementation of the pilot project “medical treatment agreement”experience based treatment recommendations to support the implementation of the medical treatment agreement in a psychiatric acute care hospitala systematic overview of the project’s phases and structuresDiscussion/conclusionAdvance Care Planning and the medical treatment agreement promote participative decision making as well as mutual confidence building, which is an important process of shared decision making in psychiatric treatment. Using the experience gained from the trialogical pilot project, we will establish the medical treatment agreement in all kbo clinics.

A joint crisis plan is a written consensus-orientated agreement between mental health service users and professionals. The instrument is used to regulate a potential future hospital treatment. At the Clinics of Upper Bavaria (kbo-Kliniken des Bezirks Oberbayern) representatives of the clinics, the organized relatives and those affected developed the pilot project "Joint Crisis Plan" in a trialogical process. The pilot project was evaluated between 2015 and 2017. The qualitative study looked at the experiences with the implementation of the instrument medical treatment agreement in different local settings. In doing so it considered the complex effects of "advance directives" on various levels such as the subjective importance and meaning as experienced by the patients, the effects on face-to-face interactions between patients and the medical staff, and the effects on institutional structures.And it considered the local influence-such as medical cultures or economic and institutional conditions-on the implementation process and the use of this instrument. The results showed that patients need numerous competences to complete a joint crisis plan. Likewise the instrument affects self-efficacy and self-images of the patients and the relation between the patients and the clinical staff in a positive way. But if the joint crisis plan is insufficiently implemented, the instrument generates rather a mortification of the self.

Zusammenfassung Krisendienst Psychiatrie f?r Oberbayern Menschen in seelischen Krisen ben?tigen ein fl?chendeckendes Notruf-Angebot. Ein gelungenes Beispiel hierf?r ist der Krisendienst Psychiatrie f?r Oberbayern in Kooperation von psychiatrischen Versorgungskliniken, Institutsambulanzen und Sozialpsychiatrischen Diensten. Sie bieten Krisenhilfe niedrigschwellig, verbindlich und zeitnah vor Ort an. Voraussetzung daf?r sind fachliche Kompetenzen bei den beteiligten Berufsgruppen und ein organisatorisch-struktureller Rahmen.