Reduction of coercive measures under routine conditions in psychiatric hospitals 2004–2019: Strong effects in old age psychiatry, much less in general psychiatry

Abstract

Background: Many interventions to reduce the use of seclusion and restraint have been suggested in the last decades. Evidence-based interventions in old age psychiatry are different from those in general psychiatry. Evidence under conditions of routine care is generally scarce. A common data base for psychiatric hospitals introduced in 2004 allowed to examine the use of seclusion and restraint in different patient groups over 16 years under routine conditions. Methods: A registry for coercive measures in the Federal State of Baden-Wuerttemberg is available since 2015 and comprises all 32 hospitals licenced to admit involuntary patients. A study group had collected data prospectively since 2004 from a subsample of these hospitals. We analysed the mean percentage of patients subjected to coercive measures and the mean cumulative duration of these interventions in ICD-10 diagnostic groups in psychiatric hospitals from 2004-2019 among a total of 1,038,239 admissions. Results: The proportion of cases affected by coercive measures dropped significantly from 28.4 % to 10.5 % in patients with ICD-10 F0 disorders, while rates in patients with other diagnoses decreased insignificantly from 7.0 % to 5.4 %. The cumulated duration of coercive measures per affected case also dropped significantly among patients with F0 disorders, while changes in patients with other diagnoses remained insiginficant. Conclusions: The use of coercive measures in patients with organic disorders could be reduced by about 50 % in a State of 11 million inhabitants within 15 years, while in contrast no substantial reduction occurred among all other diagnostic groups. Specific interventions to reduce coercive interventions seem to be particularly successful for this patient group.

Increase in coercive measures in psychiatric hospitals in Germany during the COVID-19 Pandemic

“…In line with previous work with similar methods (15,16), we chose seven outcomes, (1) the percentage of cases on any involuntary legal basis, (2) the percentage of cases that were affected by mechanical restraint, seclusion, physical restraint, emergency medication, or forced medication, (3) the duration of seclusion, mechanical, or physical restraint episodes, (4) the cumulative duration of seclusion, mechanical, or physical restraint per affected case, (5) the percentage of cases in whom aggressive behavior towards others was recorded by the SOAS-R, (6) the SOAS-R score, and (7) the number of aggressive incidents with injurious consequences.…”

“…Due to data privacy regulations, we cannot separate the first two months of 2020 from the rest of the year in the analyses. The increase in seclusion and the parallel reduction in mechanical restraint are probably not due to effects of the pandemic, but reflects a trend that had already been observed previously, following legal regulations (16).…”

“…Now we can present such data based on a total survey of all coercive interventions in psychiatric hospitals in a Federal State with 11 million inhabitants, encompassing over 200,000 cases in the years 2019 and 2020. The comparison of the data in the year before the pandemic (2019) and the first year of the pandemic (2020) confirms the devastating effects of the COVID-19 pandemic on previous achievements to reduce coercion in psychiatry, as demonstrated in the same population (5,16). The number of hospital cases decreased considerably; involuntary cases, however, increased slightly and consequently their proportion of all cases increased.…”

“…The proportion of aggressive incidents with injury consequences also remained unchanged (Table 5). on previous achievements to reduce coercion in psychiatry, as demonstrated in the same population (5,16). The number of hospital cases decreased considerably; involuntary cases, however, increased slightly and consequently their proportion of all cases increased.…”

Use and alternatives to coercive measures in inpatient residential care facilities for adults with disabilities: study protocol of a mixed-methods study

“…The collection of data on the use of restraints in psychiatric patients was mandated by law in the aforementioned decision. The state of Baden-Württemberg, however, had already included this provision in its Mental Health Act of 2015 [4,5]. While awareness of the necessity of recording data on coercive measures in psychiatric institutions has increased, this has not been the case for residential care facilities (RCFs) for adults with disabilities.…”