Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Nov 20;63(1):e102.
doi: 10.1192/j.eurpsy.2020.104.

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

Tilman Steinert  1   2 , Sophie Hirsch  1   2   3 , Rita Goebel  1   2 , Brendan Snellgrove  1   2 , Erich Flammer  1   2
Affiliations

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

Tilman Steinert et al. Eur 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. A common database for psychiatric hospitals introduced in 2004 allowed to examine the use of seclusion and restraint over 16 years under routine conditions.

Methods: A registry for coercive measures in the Federal State of Baden-Wuerttemberg has been available since 2015, and comprises all 32 hospitals licensed to admit involuntary patients. A study group had collected data prospectively since 2004 from a subsample of these hospitals. We analyzed 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 to 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.

Keywords: Coercion; epidemiology; general psychiatry; old age psychiatry.

PubMed Disclaimer

Conflict of interest statement

All authors declare that they have no conflicts of interest.

Figures

Figure 1.
Figure 1.
Proportion of cases with coercive interventions 2004–2019.
Figure 2.
Figure 2.
Cumulated duration (hours) of coercive interventions per affected case 2004–2019.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

See all "Cited by" articles

References

    1. Hirsch S, Steinert T. Measures to avoid coercion in psychiatry and their efficacy. Dtsch Arztebl Int. 2019;116:336–343. doi: 10.3238/arztebl.2019.0336. - DOI - PMC - PubMed
    1. Du M, Wang X, Yin S, Shu W, Hao R, Zhao S, et al. De-escalation techniques for psychosis-induced aggression or agitation. Cochrane Database Syst Rev. 2017;4:CD009922. doi: 10.1002/14651858.CD009922.pub2. - DOI - PMC - PubMed
    1. Thornicroft G, Farrelly S, Szmukler G, Birchwood M, Waheed W, Flach C, et al. Clinical outcomes of joint crisis plans to reduce compulsory treatment for people with psychosis: a randomised controlled trial. Lancet. 2013;381:1634–1641. doi: 10.1016/S0140-6736(13)60105-1. - DOI - PubMed
    1. Radenbach K, Falkai P, Weber-Reich T, Simon A. Joint crisis plans and psychiatric advance directives in German psychiatric practice. J Med Ethics. 2014;40:343–345. doi: 10.1136/medethics-2012-101038. - DOI - PubMed
    1. Bowers L. Safewards: a new model of conflict and containment on psychiatric wards. J Psychiatr Ment Health Nurs. 2014;21:499–508. doi: 10.1111/jpm.12129. - DOI - PMC - PubMed

Publication types