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Open Access 01-12-2021 | Care | Research article

Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics

Authors: Klaus Mann, Sonja Gröschel, Susanne Singer, Jörg Breitmaier, Sylvia Claus, Markus Fani, Stephan Rambach, Hans-Joachim Salize, Klaus Lieb

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Background

Epidemiological studies have demonstrated considerable differences in the use of coercive measures among psychiatric hospitals; however, the underlying reasons for these differences are largely unclear. We investigated to what extent these differences could be explained by institutional factors.

Methods

Four psychiatric hospitals with identical responsibilities within the mental health care system, but with different inpatient care organizations, participated in this prospective observational study. We included all patients admitted over a period of 24 months who were affected by mechanical restraint, seclusion, or compulsory medication. In addition to the patterns of coercive measures, we investigated the effect of each hospital on the frequency of compulsory medication and the cumulative duration of mechanical restraint and seclusion, using multivariate binary logistic regression. To compare the two outcomes between hospitals, odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated.

Results

Altogether, coercive measures were applied in 1542 cases, corresponding to an overall prevalence of 8%. The frequency and patterns of the modalities of coercive measures were different between hospitals, and the differences could be at least partially related to institutional characteristics. For the two hospitals that had no permanently locked wards, certain findings were particularly noticeable. In one of these hospitals, the probability of receiving compulsory medication was significantly higher compared with the other institutions (OR 1.9, CI 1.1–3.0 for patients < 65 years; OR 8.0, CI 3.1–20.7 for patients ≥65 years); in the other hospital, in patients younger than 65 years, the cumulative duration of restraint and seclusion was significantly longer compared with the other institutions (OR 2.6, CI 1.7–3.9).

Conclusions

The findings are compatible with the hypothesis that more open settings are associated with a more extensive use of coercion. However, due to numerous influencing factors, these results should be interpreted with caution. In view of the relevance of this issue, further research is needed for a deeper understanding of the reasons underlying the differences among hospitals.

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Title: Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics
Authors: Klaus Mann
Sonja Gröschel
Susanne Singer
Jörg Breitmaier
Sylvia Claus
Markus Fani
Stephan Rambach
Hans-Joachim Salize
Klaus Lieb
Publication date: 01-12-2021
Publisher: BioMed Central
Keyword: Care
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03410-z

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Evaluation of coercive measures in different psychiatric hospitals: the impact of institutional characteristics

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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