Zwangsmaßnahmen im Vergleich an sechs psychiatrischen Abteilungen

Ketelsen, Regina; Schulz, Manfred; Drießen, Martin

doi:10.1055/s-0029-1246181

Cited by 19 publications

(8 citation statements)

References 5 publications

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“…The first publication reporting data on the use of such measures in a hospital stems from 1991 (29). Beginning from 1997, two voluntary working groups of German hospitals were founded in the Southern and the Northern part of Germany with the aim to analyze and reduce the use of mechanical restraint and other types of coercion and violence (27, 30–32). Since about 2000, after introducing common definitions, first data collections and comparisons between hospitals were made, so-called “benchmarking” in quality circles (33).…”

Section: Mechanical Restraintmentioning

confidence: 99%

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

Steinert

Noorthoorn

Mulder

2014

Front. Public Health

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In this review, we compare the use of coercion in mental health care in Germany and in the Netherlands. Legal frameworks and published data on involuntary commitment, involuntary medication, seclusion, and restraint are highlighted as well as the role of guidelines, training, and attitudes held by psychiatrists and the public. Legal procedures regulating involuntary admission and commitment are rather similar, and so is the percentage of involuntary admissions and the rate per 100,000 inhabitants. However, opposing trends can be observed in the use of coercive interventions during treatment, which in both countries are considered as a last resort after all other alternative approaches have failed. In the Netherlands, for a long time seclusion has been considered as preferred intervention while the use of medication by force was widely disapproved as being unnecessarily invasive. However, after increasing evidence showed that number and duration of seclusions as well as the number of aggressive incidents per admission were considerably higher than in other European countries, attitudes changed within recent years. A national program with spending of 15 million € was launched to reduce the use of seclusion, while the use of medication was facilitated. A legislation is scheduled, which will allow also outpatient coercive treatment. In Germany, the latter was never legalized. While coercive treatment in Germany was rather common for involuntarily committed patients and mechanical restraint was preferred to seclusion in most hospital as a containment measure, the decisions of the Constitutional Court in 2011 had a high impact on legislation, attitudes, and clinical practice. Though since 2013 coercive medication is approvable again under strict conditions, it is now widely perceived as very invasive and last resort. There is evidence that this change of attitudes lead to a considerable increase of the use of seclusion and restraint for some patients.

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Section: Mechanical Restraintmentioning

confidence: 99%

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

Steinert

Noorthoorn

Mulder

2014

Front. Public Health

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“…Besides that, one has to bear in mind that prior studies followed different methodological approaches to analyze data which additionally limits the comparability between different study sites. Some studies used descriptive approaches ( 16 , 32 ) or group comparisons with binominal, non-parametric tests or ANOVA ( 17 – 20 , 22 – 24 , 26 , 29 , 30 ). To describe risk factors regression analysis was frequently used ( 19 – 21 , 23 , 26 , 28 , 29 , 31 , 33 ) and some studies extended their findings with an estimation of the area under the curve (AUC) ( 23 ).…”

Section: Introductionmentioning

confidence: 99%

Machine Learning: An Approach in Identifying Risk Factors for Coercion Compared to Binary Logistic Regression

et al. 2018

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Introduction: Although knowledge about negative effects of coercive measures in psychiatry exists, its prevalence is still high in clinical routine. This study aimed at define risk factors and test machine learning algorithms for their accuracy in the prediction of the risk to being subjected to coercive measures.Methods: In a sample of involuntarily hospitalized patients (n = 393) at the University Hospital of Psychiatry Zurich, we analyzed risk factors for the experience of coercion (n = 170 patients) using chi-square tests and Mann Whitney U tests. We trained machine learning algorithms [logistic regression, Supported Vector Machine (SVM), and decision trees] with these risk factors and tested obtained models for their accuracy via five-fold cross validation. To verify the results we compared them to binary logistic regression.Results: In a model with 8 risk-factors which were available at admission, the SVM algorithm identified 102 out of 170 patients, which had experienced coercion and 174 out of 223 patients without coercion (69% accuracy with 60% sensitivity and 78% specificity, AUC 0.74). In a model with 18 risk-factors, available after discharge, the logistic regression algorithm identified 121 out of 170 with and 176 out of 223 without coercion (75% accuracy, 71% sensitivity, and 79% specificity, AUC 0.82).Discussion: Incorporating both clinical and demographic variables can help to estimate the risk of experiencing coercion for psychiatric patients. This study could show that trained machine learning algorithms are comparable to binary logistic regression and can reach a good or even excellent area under the curve (AUC) in the prediction of the outcome coercion/no coercion when cross validation is used. Due to the better generalizability machine learning is a promising approach for further studies, especially when more variables are analyzed. More detailed knowledge about individual risk factors may help to prevent the occurrence of situations involving coercion.

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“…Mechanische Zwangsmaßnahmen in vielen Formenvon den Ketten über Fixierung mit Gurten, Zwangsjacke, Einwickeln in Tücher, Festbinden an Stühlen, Einsperren in leere Räume (Isolierung)gehören unvermeidlich zum symbolischen Inventar der Psychiatrie und prägen ihr janusköpfiges Bild in der Öffentlichkeit, wenngleich die Anwendung von Zwang heute nur noch bei einer kleinen Minderheit der Patienten eine Rolle spielt und selbst bei systematischen Befragungen zur Aufnahmesituation nur noch marginal in Erscheinung tritt [1]. Trotzdem sind auch heute noch 2-10 % der Aufnahmen in psychiatrischen Krankenhäusern von solchen mechanischen Zwangsmaßnahmen betroffen [2][3][4], die im Mittel zwischen 5 und 10…”

Section: Das äLteste Problem Psychiatrischer Institutionenunclassified

“…In Deutschland gibt es 2 klinikübergreifende Arbeitskreise, die sich seit vielen Jahren mit Zwangsmaßnahmen und deren Verhinderung beschäftigen, den vom Autor dieses Beitrags 1997 initiierten Arbeitskreis zur Prävention von Gewalt und Zwang in der Psychiatrie (www.arbeitskreis-gewaltpraevention. de) [13,14] mit Beteiligung von Kliniken aus Baden-Württemberg, Bayern, Hessen, Luxemburg, Wales und der Schweiz und ein norddeutsches Pendant mit einer kleineren Arbeitsgruppe [2,15]. Seit mittlerweile 10 Jahren vorliegende Daten aus Klinikvergleichen (Benchmarking) zeigen, dass eine erhebliche Variation zwischen den einzelnen Kliniken besteht, dass gezielte Projekte die Häufigkeit von Zwangsmaßnahmen durchaus zu senken vermögen, jedoch auch, dass ein Trend nach unten über alle Kliniken hinweg bei dem Einsatz von Fixierungen und Isolierungen bisher nicht überzeugend dargestellt werden konnte [16][17][18].…”

Section: Das äLteste Problem Psychiatrischer Institutionenunclassified

Nach 200 Jahren Psychiatrie: Sind Fixierungen in Deutschland unvermeidlich?

Steinert

2011

Psychiat Prax

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Zwangsmaßnahmen im Vergleich an sechs psychiatrischen Abteilungen

Abstract: Data interpretation should consider numerous confounding factors such as case mix and hospital characteristics. The handling of coercive measures is an important quality feature. Therefore standardised survey methods should be developed and nationwide implemented.

Cited by 19 publications

References 5 publications

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

The Use of Coercive Interventions in Mental Health Care in Germany and the Netherlands. A Comparison of the Developments in Two Neighboring Countries

Machine Learning: An Approach in Identifying Risk Factors for Coercion Compared to Binary Logistic Regression

Nach 200 Jahren Psychiatrie: Sind Fixierungen in Deutschland unvermeidlich?

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