[Recording and reducing coercive measures in psychiatric hospitals]

A project of quality management funded by the German Ministry of Health is presented which aims at recording and reducing of coercive measures (seclusion, restraint, forced medication).

Since 1997, a study group for prevention of violence and coercion consisting of physicians, nurses and other psychiatric professionals from 18 psychiatric hospitals is working in Baden-Wuerttemberg and Bayern. A common documentation of coercive measures has been introduced, variables of interest such as percentage of patients exposed to coercive measures in each principal diagnostic group of the ICD-10 have been defined for purposes of benchmarking. Aims of the project are 1) a complete documentation of all coercive measures in 12 psychiatric hospitals in a 12-month period and a benchmarking, taking into account structural characteristics of the hospitals and the respective catchment area, 2) providing a manual for a one-day de-escalation training for all professional groups working with psychiatric patients.

A pilot study demonstrated that about 9 % of all admitted patients have been exposed to coercive measures in a subset of the participating hospitals. The variance between the hospitals was rather high.