Diagnosis-related frequency of compulsory measures in 10 German psychiatric hospitals and correlates with hospital characteristics

Steinert, Tilman; Martin, Veronika; Baur, Manfred; Bohnet, Ulrich; Goebel, Rita; Hermelink, Gottfried; Kronstorfer, Rita; Küster, Wolfgang; Martinez-Funk, Beate; Röser, Martin; Schwink, A.; Voigtländer, Wolfram

doi:10.1007/s00127-006-0137-0

Cited by 82 publications

(87 citation statements)

References 28 publications

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“…It is widely accepted that effective mental health care sometimes includes the deployment of coercive measures such as seclusion and restraint by staff to contain dangerous or severely disruptive behaviour by a service user. Extensive efforts have been made in Europe and America over the past decade to assess rates of coercive measures systematically [1][2][3] and to reduce them [4]. D'Orio et al [5], for example, report a 39% reduction in coercion following introduction of a package which included enhanced access to expertise during emergency situations.…”

Section: Introductionmentioning

confidence: 99%

Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

Whittington

Bowers²,

Nolan

et al. 2009

128

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This is the accepted version of the paper.This version of the publication may differ from the final published version. Methods: A cross-sectional design was adopted. The Attitudes to Containment Measures Questionnaire (ACMQ) was completed by 1,361 service users and 1,226 staff in acute care mental health services from three regions of England. This provided evaluation of eleven coercive measures (e.g. seclusion) on six dimensions of approval (e.g. indignity, safety) in a large national sample. Comparisons between groups were tested using independent samples t-tests, χ 2 or Spearman correlations. Permanent repository linkResults: Both service users and staff disapproved strongly of mechanical restraint and expressed a relative preference for compulsory intramuscular medication and seclusion. Male staff, older service users and staff who had been involved in implementing coercion expressed greater approval of coercive measures.Conclusion: Mechanical restraint remains highly objectionable to staff and service users in English mental health services despite its widespread acceptance elsewhere in the world.

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Section: Introductionmentioning

confidence: 99%

Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

Whittington

Bowers²,

Nolan

et al. 2009

128

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show abstract

“…There is some data however, on the use of detention in hospitals and on the use of mechanical restraint (being strapped to a bed frame), physical restraint (being held down by staff), and seclusion (being locked in a small room). These vary considerably from hospital to hospital (between 2% and 10% of inpatients) [9] and between German states [10], suggesting perhaps that the use of coercion reflects the institutional culture rather than a variation in patient behavior for example between rural Bavaria and urban Hamburg.…”

Section: Introductionmentioning

confidence: 99%

Germany without Coercive Treatment in Psychiatry—A 15 Month Real World Experience

Zinkler¹

2016

Laws

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Coercive treatment with antipsychotic drugs was commonly used in German psychiatric institutions until it became a topic of substantial medical, legal and ethical controversy. In 2011 and 2012, several landmark decisions by Germany's Constitutional Court and Federal Supreme Court challenged this practice in all but life-threatening emergencies. In March 2013, the new legal provisions governing coercive treatment took effect allowing coercive medication under stricter criteria. While mainstream psychiatry in Germany resumed the use of coercive medication, although less frequently than before 2012, there are examples where clinicians put an even greater emphasis on consensual treatment and did not return to coercive treatment. Data from a case study in a local mental health service suggest that the use of coercive medication could be made obsolete.

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“…Therefore the avoidance of involuntary admissions by police is a more difficult matter, especially when there is a lack of professionals on duty to assess police and on-site carers [26] . Correlations between coercive measures and hospital characteristics were widely investigated in Germany by Steinert et al [42] in longitudinal and comparative surveys.…”

Section: Discussionmentioning

confidence: 99%

Does deinstitutionalisation work? Relationships between psychiatric outpatient and inpatient care provision in a rural German catchment area

Valdés-Stauber

Cranach²,

Putzhammer³

et al. 2013

JHA

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Objective: We intended to find out whether an intensification of outpatient care after conclusion of the deinstitutionalization era in the year 2001 had an influence on number of hospitalizations, readmission figures, length of inpatient -stay (LOS), cumulative length of inpatient-stay (cumulative LOS) and coercive measures. Method:We investigated the development of 17 inpatient and outpatient variables for 2002-10 within a district psychiatric hospital responsible for a rural catchment area of 320,000 inhabitants. The sample consisted of 31,537 inpatient admissions and 35,372 outpatients accounted on an annual basis. Some figures were compared with those at state and federal levels. Associations between aggregated hospitalization and outpatient care variables were assessed by means of robust bivariate Prais-Winsten regression models for time series.Results: Over the surveyed period, number of admissions, admitted individuals, and hospitalization rates remained stable, contrary to state and federal tendencies. Cumulative LOS and readmission figures decreased, whereas average LOS increased. Number of admissions, cumulative LOS, and readmission figures were negatively associated with number of outpatients treated which increased over the surveyed period. Number of coercive measures decreased, numbers of involuntary admissions under the guardianship law remained lower than at federal and state levels, and ambulatory activity remained three times higher than in the state in which the surveyed catchment area is located. Conclusions:Community-oriented ambulatory care on the basis of multi-disciplinary assertive teams seems to be able to reduce readmissions and cumulative length of inpatient-stay, while keeping at the same time the number of admissions and coercive measures stable. Economic and clinical effects on real inpatient care, however, cannot be definitively evaluated as long as bed provision does not decrease proportionally with the increase of ambulatory activity.

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Diagnosis-related frequency of compulsory measures in 10 German psychiatric hospitals and correlates with hospital characteristics

Cited by 82 publications

References 28 publications

Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

Approval Ratings of Inpatient Coercive Interventions in a National Sample of Mental Health Service Users and Staff in England

Germany without Coercive Treatment in Psychiatry—A 15 Month Real World Experience

Does deinstitutionalisation work? Relationships between psychiatric outpatient and inpatient care provision in a rural German catchment area

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