[Coercive measures: a comparison between six psychiatric departments]

Abstract

Objective: Although coercive measures are one of the indicators for the quality of psychiatric in-patient care, reliable and valid data comparing the practices are hardly available. The purpose of this study was to analyse the incidence and duration of mechanical restraint and seclusion in psychiatric hospitals in Germany. We hypothesised that the duration of these coercive measures is associated not only with gender and diagnosis of the patients, but also with the clinics themselves.

Methods: Incidence and duration of coercive measures (mechanical restraint and seclusion) among patients in the year 2004 were analysed in six German psychiatric hospitals. Furthermore, the association of the length of these coercive measures with diagnosis, gender, and hospital was analysed using non-parametric statistical tests.

Results: 3.0% of 10,352 cases treated in 2004 were exposed to mechanical restraint and seclusion with a range from 1.9-7.4% on comparing the hospitals. On average, these measures were applied 3.7 times per patient (case) with each single intervention lasting 5.0 h (mean, range <0.1-290.8). The incidence and duration of coercive measures varied highly between different diagnostic groups and different hospitals. The length of these measures differed significantly between hospitals (p<0.001) and diagnoses (p<0.001). In patients with organic psychiatric disorders (ICD-10: F0) we observed the longest duration. Furthermore the duration of coercive measures in female patients was shorter than that for male patients (p<0.05).

Conclusion: 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.