[After 200 years of psychiatry: are mechanical restraints in Germany still inevitable?]

Abstract

Background: Mechanical restraint and seclusion are not therapeutic interventions but procedures to safeguard patients or staff representing a failure of therapeutic approaches. Quality management including benchmarkings yields considerable variations between different hospitals. However, an enduring and significant decrease in the frequency and duration of such coercive measures so far has not been achieved by means of quality management. A new set of approaches is therefore required.

Results: Amending the British practice of "physical restraint" for German conditions, a technique of holding the patient was developed accompanied by manualised interventions of verbal de-escalation. In contrast to mechanical restraint, the technique represents a therapeutic intervention and is usually of short duration. An implementation is planned in a group of hospitals collaborating in the prevention of violence and coercion in psychiatry.

Conclusions: This new technique appears a promising approach to fundamentally change the practice of mechanical restraint in Germany. Evidence of the effect of this technique on frequency and duration of mechanical restraints needs to be gathered.