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Social Psychiatry and Psychiatric Epidemiology

, Volume 42, Issue 2, pp 140–145 | Cite as

Diagnosis-related frequency of compulsory measures in 10 German psychiatric hospitals and correlates with hospital characteristics

  • Tilman Steinert
  • Veronika Martin
  • Manfred Baur
  • Ulrich Bohnet
  • Rita Goebel
  • Gottfried Hermelink
  • Rita Kronstorfer
  • Wolfgang Kuster
  • Beate Martinez-Funk
  • Martin Roser
  • Albrecht Schwink
  • Wolfram Voigtländer
ORIGINAL PAPER

Abstract

Objective

To investigate the incidence of coercive measures in standard psychiatric care in different psychiatric hospitals.

Methods

We developed a common documentation of mechanical restraint, seclusion, and medication by coercion, and introduced it in 10 participating hospitals. We developed software able to process the data and to calculate four key indicators for routine clinical use.

Results

9.5% of 36,690 cases treated in 2004 were exposed to coercive measures with the highest percentage among patients with organic psychiatric disorders (ICD-10 F0) (28.0%). Coercive measures were applied a mean 5.4 times per case and lasted a mean 9.7 h each. The incidence and duration of coercive measures varied highly between different diagnostic groups and different hospitals. Use of detailed guidelines for seclusion and restraint was associated with a lower incidence of coercive measures.

Discussion

Data interpretation should consider numerous confounding factors such as case mix and hospital characteristics. Suggestions on how to cope with ethical and technical problems in the processing of large multi-site data sets in routine clinical use are made.

Keywords

seclusion restraint involuntary medication predictor guideline 

Notes

Acknowledgements

We thank Dr. Peter Lepping, Wrexham Maelor Hospital, Wales, for language corrections. The German Ministry of Health and Social Welfare funded the project.

References

  1. 1.
    Jones K (1984) Robert Gardiner Hill and the non-restraint movement. Can J Psychiatry 29:121–124PubMedGoogle Scholar
  2. 2.
    Colaizzi J (2005) Seclusion and restraint: a historical perspective. J Psychosoc Nurs Mental Health Serv 43:31–37Google Scholar
  3. 3.
    Sailas E, Fenton M (2000) Seclusion and restraint for people with serious mental illnesses. The Cochrane database of systematic reviews, p CD 001163Google Scholar
  4. 4.
    Fisher WA (1994) Restraint and seclusion: a review of the literature. Am J Psychiatry 151:1585–1591Google Scholar
  5. 5.
    Needham I, Abderhalden C, et al. (2002) Coercive procedures and facilities in Swiss Psychiatry. Swiss Medical Weekly 132:253–258PubMedGoogle Scholar
  6. 6.
    Salib E, Ahmed AG, Cope M (1998) Practice of seclusion: a five-year retrospective review in North Cheshire. Med Sci Law 38:321–327PubMedGoogle Scholar
  7. 7.
    Savage L, Salib E (1999) Seclusion in psychiatry. Nurs Stand 13:34–37PubMedGoogle Scholar
  8. 8.
    Nijman HLI, Palmstierna T, Almvik R, Stolker JJ (2005) Fifteen years of research with the Staff Observation Aggression Scale—a review. Acta Psychiatr Scand 111:12–21PubMedCrossRefGoogle Scholar
  9. 9.
    Frueh BC, Knapp RG, Cusack KJ, Grubaugh AL, Sauvageot JA, Cousins VC, Yim E, Robins CS, Monnier J, Hiers TG (2005) Patients’ reports of traumatic or harmful experiences within the psychiatric setting. Psychiatr Serv 56:1123–1133PubMedCrossRefGoogle Scholar
  10. 10.
    Meyer H, Taiminen T, Vuori T, Aijälä A, Helenius H (1999) Post-traumatic stress disorder symptoms related to psychosis and acute involuntary hospitalisation in schizophrenic and delusional patients. J Nerv Ment Dis 187:343–352PubMedCrossRefGoogle Scholar
  11. 11.
    Priebe S, Bröker M, Gunkel S (1998) Involuntary admission and posttraumatic stress disorder symptoms in schizophrenia patients. Compr Psychiatry 39:220–224PubMedCrossRefGoogle Scholar
  12. 12.
    Betemps EJ, Buncher CR, Oden M (1992) Length of time spent in seclusion and restraint by patients at 82 VA medical centers. Hosp Com Psychiatry 43:912–914Google Scholar
  13. 13.
    Betemps EJ, Somoza E, et al. (1993) Hospital characteristics, diagnoses and staff reasons associated with use of seclusion and restraint. Hosp Com Psychiatry 44:367–371Google Scholar
  14. 14.
    Crenshaw WB, Francis PS (1995) A national survey on seclusion and restraint in state psychiatric hospitals. Psychiatr Serv 46:1026–1031PubMedGoogle Scholar
  15. 15.
    Crenshaw WB, Cane KA (1997) An updated national survey on seclusion and restraint. Psychiatr Serv 48:395–397PubMedGoogle Scholar
  16. 16.
    Gerlock A, Solomons HC (1983) Factors associated with the seclusion of psychiatric patients. Perspect Psychiatr Care 21:46–53PubMedCrossRefGoogle Scholar
  17. 17.
    Glover RW (2005) Reducing the use of seclusion and restraint: a NASDMHPD priority. Psychiatr Serv 56:1141–1142PubMedCrossRefGoogle Scholar
  18. 18.
    Smith GM, Davis RH, Bixler EO, Lin HM, Altenor A, Altenor RJ, Hardentstine BD, Kopchick GA (2005) Pennsylvania State Hospital System’s seclusion and restraint reduction program. Psychiatr Serv 56:1115–1122PubMedCrossRefGoogle Scholar
  19. 19.
    Kaltiala-Heino R, Korkeila J, Tuohimäki C, et al. (2000) Coercion and restrictions in psychiatric inpatient treatment. Eur Psychiatry 15:213–219PubMedCrossRefGoogle Scholar
  20. 20.
    Ketelsen R, Zechert C, et al. (2001) Entwicklung eines Kooperationsmodells zwischen drei psychiatrischen Kliniken mit dem Ziel der Qualitätssicherung bei Zwangsmaßnahmen am Beispiel der Fixierungsdokumentation. Psychiat Prax 28:69–74CrossRefGoogle Scholar
  21. 21.
    Steinert T (2000) Reduzierung von Gewalt und Zwang an psychiatrischen Kliniken. Krankenhauspsychiatrie 11:53–59Google Scholar
  22. 22.
    Howell DC (2000) Resampling procedures. URL: http://www.uvm.edu/∼dhowell/StatPages/Resampling/Resampling.html
  23. 23.
    Fritz U, Mack B, Rave-Schwank M (1991) Gewalt in der Psychiatrie. Evaluation der Fixierungsdokumentation in einem psychiatrischen Krankenhaus. Psychiat Prax 18:162–166Google Scholar
  24. 24.
    Klimitz H, Uhlemann H, Fähndrich E (1998) Fixieren wir zu häufig? Indikation, Häufigkeit und Randbedingungen von Fixierungen in einer allgemeinpsychiatrischen Abteilung. Psychiat Prax 25:235–239Google Scholar
  25. 25.
    Swett C (1994) Inpatient seclusion: description and causes. Bull Am Acad Psychiatry Law 22:421–430PubMedGoogle Scholar
  26. 26.
    Tunde-Ayinmode M, Little H (2004) Use of seclusion in an psychiatric acute inpatient unit. Austr Psychiatry 12:347–353CrossRefGoogle Scholar
  27. 27.
    Thompson P (1986) The use of seclusion in psychiatric hospitals in the Newcastle area. Br J Psychiatry 149:471–474PubMedCrossRefGoogle Scholar
  28. 28.
    Tardiff K (1981) Emergency control measures for psychiatric inpatients. J Nerv Ment Dis 169:614–618PubMedCrossRefGoogle Scholar
  29. 29.
    Brown JS, Tooke SK (1992) On the seclusion of psychiatric patients. Soc Sci Med 35:711–721PubMedCrossRefGoogle Scholar
  30. 30.
    Bush AB, Shore MF (2000) Seclusion and restraint; a review of recent literature. Harv Rev Psychiatry 8:261–270CrossRefGoogle Scholar
  31. 31.
    Esther RJ (1997) Use of physical restraints in a nineteenth-century state hospital. Hist Psychiatry 8:83–93PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • Tilman Steinert
    • 1
  • Veronika Martin
    • 1
  • Manfred Baur
    • 2
  • Ulrich Bohnet
    • 3
  • Rita Goebel
    • 1
  • Gottfried Hermelink
    • 4
  • Rita Kronstorfer
    • 5
    • 6
  • Wolfgang Kuster
    • 7
  • Beate Martinez-Funk
    • 8
  • Martin Roser
    • 9
  • Albrecht Schwink
    • 10
  • Wolfram Voigtländer
    • 11
  1. 1.Centre of Psychiatry WeißenauUniversity of UlmRavensburg-WeißenauGermany
  2. 2.Bezirkskrankenhaus KaufbeurenKaufbeurenGermany
  3. 3.Zentrum für Psychiatrie ReichenauReichenauGermany
  4. 4.Vinzenz von Paul HospitalRottweilGermany
  5. 5.Klinikum am WeißenhofWeinsbergGermany
  6. 6.Wrexham Maelor HospitalWrexhamUK
  7. 7.Klinik für Psychiatrie und NeurologieWinnendenGermany
  8. 8.Klinik an der LindenhöheOffenburgGermany
  9. 9.Klinikum NordschwarzwaldCalw-HirsauGermany
  10. 10.Zentrum für Psychiatrie EmmendingeEmmendingenGermany
  11. 11.Klinikum HeidenheimHeidenheimGermany

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