Non-coercive techniques for the management of crises in mental health settings in Germany-a narrative review.

Coercion is common in mental health care settings in Germany. At the same time, considerable efforts are undertaken to reduce and ultimately abolish coercive interventions. Need adapted treatment, open door policies, and moving away from the biomedical model of mental illness can contribute to non-coercive care.

The WHO QualityRights initiative: building partnerships among psychiatrists, people with lived experience and other key stakeholders to improve the quality of mental healthcare.

Psychiatrists have an essential role to play in promoting human rights in mental healthcare. The World Health Organization's QualityRights initiative, in partnership with different stakeholders, is improving the quality of psychiatric care in different countries.

[Open-door psychiatry and community mental health work].

In connection with the UN Convention on the Rights of Persons with Disabilities, mental healthcare concepts increasingly focus on the prevention of violence and coercion. Hospital care with an open-door policy is linked with a reduction in violence and coercive measures. The authors describe a specific therapeutic milieu aiming to promote social resources and to reduce institutional exclusion.

[Inpatient Mental Health Care without Mechanical Restraint, Seclusion or Compulsory Medication].

Mechanical restraint is a common occurance in Germany's mental health care facilities; less common though not unusual are seclusion and compulsory medication. The authors describe a model to calculate additional resources required to provide mental health care without any of these forms of coercive measures. An analysis of actual clinical situations that led to mechanical restraint provides information of the 1:1, 2:1 or 3:1 intensive support necessary to cope with crises in inpatient mental health care.

Aggression and violence in psychiatric hospitals with and without open door policies: A 15-year naturalistic observational study.

Aggressive behavior and violence in psychiatric patients have often been quoted to justify more restrictive settings in psychiatric facilities. However, the effects of open vs. locked door policies on aggressive incidents remain unclear.

Scenarios for the future of mental health care: a social perspective.

Social values and concepts have played a central role in the history of mental health care. They have driven major reforms and guided the development of various treatment models. Although social values and concepts have been important for mental health care in the past, this Personal View addresses what their role might be in the future.

[What is a "Considerable Damage to One's Health" in the Sense of German Guardianship Law?].

The term of a "considerable damage to one's health" is central in German guardianship law with respect to judge's decisions on involuntary commitment and coercive treatment. A legal definition has not been provided, and up to now no explanations from the part of medicine have been available what a "considerable damage to one's health" is in the case of mental illness and how it can be determined. A consensus paper of the German Association of Psychiatry and Psychotherapy (DGPPN) explains four possible scenarios of manifestation of such kind of damage, corresponding to somatic illnesses: evidence of structural brain lesions (rare), subjective suffering (sufficient, but not necessary), impairment of functioning in important areas of life, and severe impairment of social participation (e.

[Long-Term Tendencies in the Use of Seclusion and Restraint in Five Psychiatric Hospitals in Germany].

Objective: To evaluate multiple efforts of the last decade to reduce the use of coercive measures in psychiatric hospitals.

Method: A working group for the prevention of violence and coercion in psychiatric hospitals has compared several outcome indicators since the year 2000 and repeatedly has provided evidence-based recommendations for clinical practice. We present data from those 5 hospitals with complete data sets recorded by an identical method over 9 years.

Effectiveness and cost-effectiveness of dialectical behaviour therapy for self-harming patients with personality disorder: a pragmatic randomised controlled trial.

Background: A primary goal of dialectical behaviour therapy (DBT) is to reduce self-harm, but findings from empirical studies are inconclusive. The aim of this study was to assess the effectiveness and cost-effectiveness of DBT in reducing self-harm in patients with personality disorder.

Methods: Participants with a personality disorder and at least 5 days of self-harm in the previous year were randomised to receive 12 months of either DBT or treatment as usual (TAU).

[Fatal aspiration following polydipsia in schizophrenia].

Objective And Methods: Polydipsia with hyponatraemia commonly occurs with chronic psychosis and is associated with a reduced life expectancy for individuals diagnosed with schizophrenia. We describe a 51 years old man who presented with polydipsia during a relapse of paranoid schizophrenia. While treated with Clozapine, and despite regular observation and daily control of creatinine and electrolytes, the man suddenly collapsed and died after drinking huge amounts of water.

Mental healthcare reform in the Republic of Moldova.

Mental healthcare in the countries of the former Soviet Union faces considerable challenges as result of the socio-economic transition. In this article we look at the changes in the Republic of Moldova. We identify weaknesses and strengths in the traditional hospital-based system and describe examples of the successful implementation of modern mental health services.

A typology of advance statements in mental health care.

Advance statements documenting mental health service consumers' preferences for treatment during a future mental health crisis or period of incapacity have gained currency in recent years in the United States and some European countries. Several kinds of advance statements have emerged -- some as legal instruments, others as treatment planning methods -- but no formal comparison has been made among them. This article reviews the literature in English and German to develop a comparative typology of advance statements: joint crisis plans, crisis cards, treatment plans, wellness recovery action plans, and psychiatric advance directives (with and without formal facilitation).

[Psychiatric nursing and community mental health care in London].

We examine the role of nurses in community mental health care. We describe training, careers, specialization and discuss new trends and problems. We look at what psychiatric nurses stand for, how they relate to other professions and new developments in research.

Detention of the mentally ill in Europe--a review.

Objective: The frequency of compulsory admission varies widely across Europe. Although there has been some research on a nation-wide level, no work has been done to compare mental health legislation in different countries in relation to detention rates and to patients' perception of hospital detention.

Method: Databases and government statistics were searched for regional, national and European data.