[Autonomy focusing as guiding idea of minimally restrictive psychiatry]

Coercion and violence in psychiatric inpatient settings represent a serious challenge. This challenge cannot be successfully met just by denying any legitimation of coercive measures or by assuming that violence from the patients' side is a fateful complication. Coercive measures are essentially approximative solutions of interpersonal and intrapersonal conflicts of autonomy, if these cannot be resolved without violence. Therefore, prevention of coercive measures can only succeed when the focus is on the needs and rights for autonomy of all subjects involved, including patients, relatives and staff. Autonomy-focused psychiatry targets transparency of conflicts of interests and aims at limiting coercive measures to the absolute minimum necessary by preventive means. A number of effective measures are available to achieve a comprehensive implementation strategy. Using these measures in clinical practice must evolve, however, during a dynamic continuous improvement process and implementation should be based on the local as well as legal, administrative and architectural situation and the available human resources. The presently widespread prioritization of opening closed psychiatric wards is insufficient to effectively minimize coercion and violence in psychiatric inpatient settings.