Long-term reduction of seclusion and forced medication on a hospital-wide level: Implementation of an open-door policy over 6 years

Hochstrasser, Lisa; Fröhlich, Daniela; Schneeberger, Andres R.; Borgwardt, Stefan; Lang, Undine E.; Stieglitz, Rof-Dieter; Huber, Christian G.

doi:10.1016/j.eurpsy.2017.09.008

Cited by 34 publications

(20 citation statements)

References 24 publications

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“…Due to the rising number of cases treated in the UPK, the percentage of involuntary admission decreased from 13.8% in 2000 (33) to 10.6% in 2013–2015. This might have exerted a positive effect on the mean clinical severity of cases and on the therapeutic atmosphere, further supporting the positive effects of the introduction of an open-door strategy in the hospital (22, 28, 29). In total, the frequency of involuntary admissions in our study is within the range found across Europe, with a minimum of 12.4 per 100,000 inhabitants in Italy and up to 232.5 per 100,000 inhabitants in Finland and with considerable national and regional variations (20, 39).…”

Section: Discussionmentioning

confidence: 70%

Compulsory Admission to Psychiatric Wards–Who Is Admitted, and Who Appeals Against Admission?

et al. 2019

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Background: When persons with a mental illness present a danger to themselves or others, involuntary hospital admission can be used to initiate an immediate inpatient treatment. Often, the patients have the right to appeal against compulsory admission. These processes are implemented in most mental health-care systems, but regulations and legal framework differ widely. In the Swiss canton of Basel-Stadt, a new regulation was implemented in January 2013. While the current literature holds some evidence for factors associated with involuntary admission, knowledge on who uses the right to appeal against admission is sparse. Aims: The study aims to examine if specific sociodemographic and clinical characteristics are associated with involuntary admission and with an appeal against the compulsory admission order. Method: Routine clinical data of all inpatient cases admitted during the period from January 2013 to December 2015 at the Psychiatric University Hospital Basel were extracted. Generalized estimating equation (GEE) analyses were used to examine the association of sociodemographic and clinical characteristics with “involuntary admission” and “appeal against compulsory admission order.” Results: Of the 8,917 cases included in the present study, 942 (10.6%) were admitted involuntarily. Of these, 250 (26.5%) lodged an appeal against the compulsory admission order. Compared with cases admitted on a voluntary legal status, cases admitted involuntarily were older and were admitted more often during the nighttime or weekend. Moreover, involuntarily admitted cases had more often a principal diagnosis of a schizophrenia spectrum disorder. Patients from cases where an appeal was lodged were more often female, had more often Swiss nationality, and were more often diagnosed with schizophrenia spectrum disorder. Conclusion: Despite legal changes, the frequency of involuntary admissions in the observed catchment area seems to be relatively stable across the last 20 years. The percentage of appeals has decreased from 2000 to 2015, and only comparably few patients make use of the possibility to appeal. Better knowledge of the regulations, higher social functioning, and lower insight into illness might be associated with a higher probability of lodging an appeal. Future research should examine if specific patient groups are in need of additional assistance to exert their rights to appeal.

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Section: Discussionmentioning

confidence: 70%

Compulsory Admission to Psychiatric Wards–Who Is Admitted, and Who Appeals Against Admission?

et al. 2019

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“…This does not necessarily have to result in an increase of seclusion or coercive interventions in general. On the contrary, there is evidence that coercive interventions including seclusion can be significantly reduced by the introduction of an open-door policy [ 11 , 14 , 37 ]. Furthermore, there are less restrictive and voluntary alternatives to seclusion such as “soft rooms” which are already known from “Soteria” concepts [ 38 ].…”

Section: Discussionmentioning

confidence: 99%

Requirements for the implementation of open door policies in acute psychiatry from a mental health professionals’ and patients’ view: a qualitative interview study

et al. 2018

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BackgroundTreating legally committed patients on open, instead of locked wards is controversially discussed and the affected stakeholders (patients, mental health professionals) have ambiguous views on the benefits and disadvantages. The study aims to assess the opinions and values of relevant stakeholders with regard to the requirements for implementing open wards in psychiatric hospitals.MethodsSemi-structured interviews were conducted with 15 psychiatrists, 15 psychiatric nurses and 15 patients, and were analyzed using qualitative content analysis.ResultsThe interviewees identified conceptual, personnel and spatial requirements necessary for an open door policy. Observation and door watch concepts are judged to be essential for open wards, and patients appreciate the therapeutic value they hold. However, nurses find the door watch problematic. All groups suggest seclusion or small locked divisions as a possible way of handling agitated patients. All stakeholders agree that such concepts can only succeed if sufficient, qualified staff is available. They also agree that freedom of movement is a key element in the management of acutely ill patients, which can be achieved with an open door policy. Finally, the interviewees suggested removing the door from direct view to prevent absconding.ConclusionsFor psychiatric institutions seeking to implement (partially) open wards, the present results may have high practical relevance. The stakeholders’ suggestions also illustrate that fundamental clinical changes depend on resource investments which – at least at a certain point – might not be feasible for individual psychiatric institutions but presumably require initiatives on the level of mental health care providers or policy makers.

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“…Die genannten Aspekte möglicher Stigmatisierung sind jedoch auch bei der Verlegung von "offenen" auf "geschlossene" Stationen traditionellen Zuschnitts immanent. Zuletzt sei noch angemerkt, dass obwohl offene Türen und flexible Ausgangsregelungen die Anwendung von Zwangsmaßnahmen deutlich reduzieren [24], das Risiko für ein zwischenzeitliches Entweichen von Patienten mit einer Unterbringung nach den Gesetzen zur Unterbringung psychisch Kranker der Bundesländer oder dem BGB ansteigen kann, obwohl empirische Untersuchungen diese naheliegende Vermutung allenfalls in geringen Ausmaß bestätigen [20,24]. Diese Neuorientierung kann bei Amtsrichtern, Polizeibeamten und Menschen in der Nachbarschaft einer psychiatrischen Klinik auf Unverständnis stoßen.…”

Section: Aspekte Der Fort-und Weiterbildung Im Track-konzeptunclassified

Das ZI-Track-Konzept in der modernen Psychiatrie: Eine syndromspezifische sektorenübergreifende Behandlung

Leweke

Hirjak

Staudter

et al. 2019

Fortschr Neurol Psychiatr

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ZusammenfassungDie leitliniengerechte Versorgung wiederkehrend oder chronisch psychisch kranker Menschen stellt eine Herausforderung dar, die sowohl sich entwickelnden diagnostischen und therapeutischen Möglichkeiten als auch den gesellschaftlichen und ökonomischen Rahmenbedingungen Rechnung tragen muss. Durch diese Veränderungen ergibt sich die Notwendigkeit zur Weiterentwicklung von stationären, tagesklinischen und ambulanten Behandlungsansätzen. Eine vielversprechende Behandlungsalternative bietet das sogenannte „Track-Konzept“. Ein „Track“ bzw. eine „Track-Einheit“ ist als eine symptom- und syndromspezifisch ausgerichtete, dezentral arbeitende, modular aufgebaute und an die individuellen Bedürfnisse der Patienten angepasste sektorenübergreifend integrierte stationär-teilstationär-ambulante Einheit zu verstehen. Dieses Konzept erlaubt es, Patienten über die gesamte Spanne der psychiatrischen Versorgung von der Diagnostik und Therapie in der Akutphase über die stationäre und teilstationäre Regelbehandlung bis hin zur ambulanten Betreuung ohne Brüche stadiengerecht eine Behandlungskontinuität anzubieten. Obwohl das Track-Konzept zur Verbesserung der Versorgungsqualität bei gleichzeitiger Sicherung der wirtschaftlichen Leistungsfähigkeit einer Klinik substantiell beitragen kann, stellt seine Umsetzung im klinischen Alltag eine Herausforderung dar. Die vorliegende Arbeit widmet sich den theoretischen Gesichtspunkten eines setting-übergreifenden Behandlungssystems im psychiatrisch-psychotherapeutischen Bereich. Dabei haben die Autoren den Anspruch, diese alternative Therapiemodalität aus ethischen, therapeutischen, personellen und weiterbildungsrelevanten Perspektiven zu beleuchten.

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Long-term reduction of seclusion and forced medication on a hospital-wide level: Implementation of an open-door policy over 6 years

Abstract: This underlines the potential of the introduction of an open-door policy to attain a long-term reduction in involuntary measures.

Cited by 34 publications

References 24 publications

Compulsory Admission to Psychiatric Wards–Who Is Admitted, and Who Appeals Against Admission?

Compulsory Admission to Psychiatric Wards–Who Is Admitted, and Who Appeals Against Admission?

Requirements for the implementation of open door policies in acute psychiatry from a mental health professionals’ and patients’ view: a qualitative interview study

Das ZI-Track-Konzept in der modernen Psychiatrie: Eine syndromspezifische sektorenübergreifende Behandlung

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