Wie können psychiatrische Kliniken in Österreich vollständig offen geführt werden?

Steinert, Tilman; Scharfetter, Joachim

doi:10.1055/a-0597-8123

Cited by 8 publications

(6 citation statements)

References 15 publications

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“…Another possible explanation of fewer IPAs during lockdowns in our study could be the reduction in psychiatric hospital beds during the COVID-19 pandemic, 23 as the association of available beds and the number of IPAs has been well described in the literature. 13 It also seems important to mention the effects of the COVID-19 prevention strategies on the open-door policy of many psychiatric hospitals in Austria, 29 as a corresponding open-door policy could no longer be maintained, at least temporarily. Open-door policies tend to be associated with lower accommodation rates, at least in Austria.…”

Section: Discussionmentioning

confidence: 99%

A country report: impact of COVID-19 lockdowns on involuntary psychiatric treatment in Austria

Fellinger,

Waldhör,

Vyssoki

et al. 2023

BJPsych open

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Background Coercive measures such as involuntary psychiatric admission are considered a last resort in the treatment of people with psychiatric disorders. So far, numerous factors have been identified that influence their use. However, the link between a pandemic – in particular, restrictions such as lockdowns – and the use of involuntary psychiatric admission is unclear. Aim To examine the association between COVID-19 lockdowns and involuntary psychiatric admissions in Austria. Method This retrospective exploratory study assessed all involuntary psychiatric admissions and use of mechanical restraint in Austria, except for the federal state of Vorarlberg, between 1 January 2018 and 31 December 2020. Descriptive statistics and regression models were used. Results During the 3-year study period, 40 012 individuals (45.9% females, mean age 51.3 years) had 66 124 involuntary psychiatric admissions for an average of 10.9 days. Mechanical restraint was used during 33.9% of these admissions. In weeks of nationwide COVID-19 lockdowns (2020 v. 2018/2019), involuntary psychiatric admissions were significantly fewer (odds ratio = 0.93, P = 0.0001) but longer (11.6 (s.d.: 16) v. 10.9 (s.d.: 15.8) days). The likelihood of involuntary admission during lockdowns was associated with year (2020 v. 2018–2019; adjusted odds ratio = 0.92; P = 0.0002) but not with sex (P = 0.814), age (P = 0.310), use of mechanical restraint (P = 0.653) or type of ward (P = 0.843). Conclusions Restrictions such as lockdowns affect coercive measures and resulted in fewer but longer involuntary psychiatric admissions during weeks of lockdown in Austria. These results strengthen previous findings that showed the dependence of coercive measures on external factors, highlighting the need to further clarify causality and desired prevention effects when using coercive measures.

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Section: Discussionmentioning

confidence: 99%

A country report: impact of COVID-19 lockdowns on involuntary psychiatric treatment in Austria

Fellinger,

Waldhör,

Vyssoki

et al. 2023

BJPsych open

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“…Das Thema Zwang in der psychiatrischen Versorgung bleibt virulent und die Möglichkeiten und Grenzen präventiver Maßnahmen werden weiter diskutiert [4]. In der Psychiatrischen Praxis erschien eine ganze Reihe weiterer Arbeiten dazu [5][6][7].…”

Section: Vermeidung Von Zwang Aus Patientenperspektiveunclassified

Die meistzitierten Arbeiten des 44. Jahrgangs der Psychiatrischen Praxis – Herzlichen Glückwunsch!

Kramer

Riedel‐Heller

2020

Psychiat Prax

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Zu Beginn des neuen Jahres möchten wir an dieser Stelle wieder die meistzitierten Arbeiten unserer Zeitschrift küren und würdigen. Deutlich standen dabei die Fragen einer menschenwürdigen und patientenorientierten Psychiatrie im Vordergrund und erneut waren es Arbeiten zum Thema Vermeidung von Zwang in der Psychiatrie, die auf den vorderen Plätzen landeten. Wir freuen uns zudem, dass wir diesmal ausnahmslos Publikationen würdigen können, die in Erstautorschaft von jungen Nachwuchswissenschaftlerinnen und Nachwuchswissenschaftlern eingereicht wurden.

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“…For this reason, in Austria it is prohibited to treat voluntary patients on wards with locked doors. As a consequence, locked wards are nearly non-existent there [ 2 ]. In Germany, approximately 10% of the patients being treated in psychiatric acute care units, most of them locked, stay there involuntarily due to a court’s decision [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Open Doors by Fair Means: a quasi-experimental controlled study on the effects of an open-door policy on acute psychiatric wards

Schreiber

Metzger

Flammer

et al. 2022

BMC Health Serv Res

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Background Psychiatric wards treating involuntarily admitted patients are traditionally locked to prevent absconding. However, on the basis of observational evidence, the necessity for locked units in psychiatric hospitals has increasingly been questioned. Updated Mental Health Laws in several Federal States of Germany legitimate involuntary commitment without generally locked doors. Methods We examined the effects of an open-door policy in a quasi-experimental, prospective design. For the first time, at each of two locations, two identical wards serving as control and intervention could be compared. After a baseline period of three months, one ward at each location started the 12 month intervention period with the implementation of an open-door policy, while the respective control ward, as before, used open doors only facultatively. Primary outcomes were average opening times of the four wards between 8 a.m. and 8 p.m., and the number of involuntary treatment days with the doors open. Secondary outcomes were adverse events including aggressive incidents, absconding, suicide attempts and coercive measures. Results Overall, door-opening times increased significantly at both sites´ intervention wards. The number of adverse events did not increase during intervention period. Frequencies of coercive measures decreased in Friedrichshafen and remained unchanged in Tuebingen. In case of the intervention ward in Friedrichshafen, doors were open in up to 91% of all involuntary treatment days, whereas in the control ward, this was only the case in 67% of all involuntary treatment days (p < .001). In case of the intervention ward in Tuebingen, 45% of involuntary treatment days had open doors, compared to 30% in the control ward (p < .001). Conclusions It is possible to manage psychiatric wards with open doors without taking inappropriate risks. The extent to which open-door policies are achievable is be dependent on staffing and patient characteristics. Further research is necessary to explore the role of staff attitudes. Trial registration Our trial "Open Doors by Fair Means" is retrospectively registered with DRKS (DRKS00015154) on Sept. 10th 2018 and displayed on the public web site. It is searchable via its meta-registry (http://apps.who.int/trialsearch/).

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Wie können psychiatrische Kliniken in Österreich vollständig offen geführt werden?

Abstract: The results do not provide evidence that the open door policy in Austrian psychiatry is realized by use of other coercive measures. Possibly more nursing staff is important to open doors.

Cited by 8 publications

References 15 publications

A country report: impact of COVID-19 lockdowns on involuntary psychiatric treatment in Austria

A country report: impact of COVID-19 lockdowns on involuntary psychiatric treatment in Austria

Die meistzitierten Arbeiten des 44. Jahrgangs der Psychiatrischen Praxis – Herzlichen Glückwunsch!

Open Doors by Fair Means: a quasi-experimental controlled study on the effects of an open-door policy on acute psychiatric wards

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