Background
Involuntary medication
in psychiatric treatment of inpatients is highly controversial. While laws
regulating involuntary medication have been changed in Germany, no data have
been available to date on how often involuntary medication is actually applied.
Recently, our hospital group introduced specific routine documentation of legal
status and application of involuntary medication in the patients’ electronic
records, which allows the assessment of the frequency of involuntary
medication.
Method
For the year 2014, we
extracted aggregated data from the electronic database on age, sex, psychiatric
diagnosis, legal status during admission, kind of coercive measure (mechanical
restraint, seclusion, and involuntary medication) applied, and the number and
duration of seclusion and restraint episodes for seven study sites.
Results
A total of 1,514 (9.6%)
of 15,832 admissions were involuntary. At least one coercive measure was
applied in 976 (6.2%) admissions. Seclusion was applied in 579 (3.7%)
admissions, mechanical restraint was applied in 529 (3.3%) admissions, and
involuntary medication was applied in 78 (0.5%) admissions. Two-thirds of
involuntary medications were applied in cases of emergency; the remainder was
applied after a formal decision by a judge. In 55 (70.5%) of the admissions with
involuntary medication, at least one other coercive measure (seclusion,
restraint, or both) was applied as well.
Conclusion
Involuntary medication
is rarely applied and less frequent than seclusion or mechanical restraint,
possibly as a consequence of recent legal restrictions.
Table 2
Affected cases, number, and duration of coercive measures according to legal status.
| Legal status | Coercive measurea | Totalb | |||
|---|---|---|---|---|---|
| Seclusion | Mechanical restraint | Involuntary medication as an emergency measure | Involuntary medication after judge’s decision | ||
| Voluntary (n = 14,318) | 263 (1.8%) | 228 (1.6%) | 12 (0.1%) | 0 (0.0%) | 455 (3.2%) |
| Detained according to mental health legislation (n = 1,026) | 187 (18.2%) | 220 (21.4%) | 31 (3.0%) | 17 (1.7%) | 347 (33.8%) |
| Detained according to guardianship legislation (n = 488) | 129 (26.4%) | 81 (16.6%) | 17 (3.5%) | 12 (2.5%) | 174 (35.7%) |
| Total (N = 15,832) | 579 (3.7%) | 529 (3.3%) | 60 (0.4%) | 29 (0.2%) | 976 (6.2%) |
| Number of coercive measures | 3,016 | 1,962 | 5,125 | ||
| Duration (h; mean, SD) | 5.5 (7.9) | 8.1 (7.2) | 6.5 (7.7) | ||
aAll percentages reflect the proportion of the row total.
bAdmissions who suffered more than one coercive measure are only totaled once.
Full article at:
By:
1Clinic for Psychiatry and Psychotherapy I,
Centers for Psychiatry Suedwuerttemberg, Versorgungsforschung Weissenau, Ulm
University, Ravensburg, Germany
Edited by: Samantha Battams, Torrens University Australia,
Australia
Reviewed by: Matthias Jaeger, University Hospital of
Psychiatry Zürich, Switzerland; Charles Bonsack, Université de Lausanne,
Switzerland
*Correspondence: Erich Flammer, Email: ed.murtnez-pfz@remmalf.hcire
Specialty section: This article was submitted to Public
Mental Health, a section of the journal Frontiers in Psychiatry
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