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Published Online: 1 August 2016

Association Between Restriction of Involuntary Medication and Frequency of Coercive Measures and Violent Incidents

Abstract

Objective:

In the German federal state of Baden-Wuerttemberg, involuntary medication of psychiatric inpatients was illegal during eight months from July 2012 until February 2013. The authors examined whether the number and duration of mechanical coercive measures (seclusion and restraint) and the number and severity of violent incidents changed in this period.

Methods:

A cross-sectional analysis was conducted of admission-related routine data collected in seven psychiatric hospitals in three time periods (period 1, July 2011–February 2012; period 2, July 2012–February 2013; and period 3, July 2013–February 2014). All patients with psychotic disorders and at least one admission during at least one of the three time periods were included (N=2,071), for a total of 3,482 admissions.

Results:

The mean number of mechanical coercive measures and violent incidents per admission increased significantly during period 2, when involuntary medication was not possible, and decreased significantly during period 3. They also differed significantly between periods 1 and 3. The percentage of admissions involving seclusion increased during period 2 significantly and was significantly different during period 1 compared with period 3. The severity of illness and the length of hospitalization did not change over the three periods.

Conclusions:

Restriction of involuntary medication was associated with a significant increase in use of mechanical coercive measures and violent incidents.

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Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: pocket watch, by Robert et Courvoisier, 1800–1816. Silver, brass, ormuolu, enamel, and steel. Bequest of Henry Francis du Pont, Winterthur Museum, Winterthur, Del.

Psychiatric Services
Pages: 1315 - 1320
PubMed: 27476807

History

Received: 6 November 2015
Revision received: 3 March 2016
Accepted: 12 April 2016
Published online: 1 August 2016
Published in print: December 01, 2016

Keywords

  1. Violence/aggression
  2. Seclusion and restraint
  3. involuntary treatment
  4. legislation

Authors

Details

Erich Flammer, Dr.Biol.Hum.
The authors are with the Department of Psychiatry and Psychotherapy I, Ulm University, and the Centers for Psychiatry Suedwuerttemberg, Ravensburg, Baden-Wuerttemberg, Germany (e-mail: [email protected]).
Tilman Steinert, Prof.Dr.Med.
The authors are with the Department of Psychiatry and Psychotherapy I, Ulm University, and the Centers for Psychiatry Suedwuerttemberg, Ravensburg, Baden-Wuerttemberg, Germany (e-mail: [email protected]).

Funding Information

Dr. Flammer reports no financial relationships with commercial interests. Dr. Steinert receives funding from the German Psychiatric Association for development of a guideline on aggressive behavior and from the German Ministry of Health for future research on coercive interventions.

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