[Involuntary treatment under guardianship law in psychiatric hospitals in Germany: results of an online survey].

Aim Of The Study: To determine the circumstances of involuntary treatment under the German Civil Code (BGB) in psychiatric hospitals serving a catchment area.

Method: Medical directors of psychiatric hospitals in Germany, including psychiatric departments at general hospitals and university clinics, were interviewed by means of an online survey.

Results: The response rate among the N=397 institutions addressed was 43%.

[Implementation of the guidelines on the prevention of violence and coercion: pre-post analysis of the randomized controlled PreVCo study].

Aim Of The Study: This study examines the extent to which a structured implementation of guidelines for the prevention of coercion leads to an improvement in guideline-compliant work and the reduction of coercion in routine clinical practice.

Methods: This is a secondary analysis of the shift of outcomes in the PreVCo study, which was conducted on 55 psychiatric wards throughout Germany.

Results: The number of coercive measures decreased significantly during the observation period.

[Mental healthcare in South Tyrol].

Mental healthcare in South Tyrol, as everywhere in Italy, is still characterized by Law 180, which came into force in 1978 under the leadership of Franco Basaglia and Bruno Orsini. The Ministry of Health subsequently set a target number of beds of 10/100,000 inhabitants. Unlike in other parts of Italy, private clinics play a minimal role in South Tyrol.

Abolition of coercion in mental health services - A European survey of feasibility.

Background: In 2019, the Council of Europe agreed to urge member states to take steps toward total abolition of psychiatric coercive measures.

Aims: To test if this aspiration is perceived as realistic and what the alternative would be in the event of a total abolition, we surveyed members of the European FOSTREN network of mental health practitioners and researchers, which is specifically dedicated to exchanging knowledge on reducing psychiatric coercion to its minimum.

Methods: Web-based survey.

[Advance directives and mental disorders: a practice recommendation of the Commission for Ethics and Law of the German Association for Psychiatry, Psychotherapy and Psychosomatics].

Background: Since the creation of legal requirements for advance directives by the legislator in 2009, special aspects of their application in the treatment of people with mental illnesses have been discussed.

Goal Of The Paper: Important questions on dealing with advance directives in everyday life will be answered in a practice-oriented manner.

Results: Among other things, this document answers the question of the conditions under which a patient can refuse or consent to hospitalization and treatment in advance, and in particular how to deal with advance directives whose implementation would also affect the rights of third parties.

[Implementation of an Open Door Policy on Two Acute Care Units].

Background: Since the amendments to the Baden-Württemberg Psychiatric Assistance Act, psychiatric patients who are treated involuntarily can be admitted to open wards. As a result, a comprehensive research project was carried out to implement an open-door policy. This work evaluates the attitudes of patients and therapeutic teams.

Forensic aspects of dissociative positive symptoms in trauma-related disorders and borderline personality disorder.

A psychotically motivated act or an act committed under impaired insight and control of action in the midst of an acute psychosis is the standard for lack of criminal responsibility. There is now increasing evidence that positive symptoms, particularly in the form of hallucinations and delusions, in trauma-related disorders and borderline personality disorder (BPD) are comparable to positive symptoms in psychotic disorders, posing a challenge for differential diagnosis and forensic assessment of the relevance of positive symptoms to insight and self-control. Due to the indistinguishability of the phenomena, there is both a risk of misdiagnosis of a psychotic disorder and also trivialization with the use of pseudo-hallucinations or quasi-psychotic labels.

Searching for diagnoses and subgroups: a suggestion for criteria.

New subgroups of psychiatric disorders are often claimed. In contrast, classification systems have repeatedly had to abandon established subgroups such as paranoid vs. disorganised and catatonic schizophrenia due to lack of empirical evidence.

Estimating costs of bedside assessment by a judge in each case of mechanical restraint in Germany after new legislation.

Background: In 2018, the German Federal Constitutional Court decided that mechanical restraint is the most intrusive coercive measure and its use requires a judge's decision after bedside assessment if lasting longer than 30 min. Subsequently, legal changes were realized. The objective of our study was to determine the number of saved coercive episodes and saved hours in seclusion or restraint in 2019 compared to the average of the previous years, 2015-2017, as well as costs per saved episode, hour, and case saved from any coercive measure.

[Coercive Medication: Who, how, how Long? A Retrospective Chart Analysis in 6 Hospital Sites in Baden-Wuerttemberg].

Background: Evaluation of the practice of coercive treatment in Germany after the Constiutional Court's decision in 2011.

Methods: The documented emergency treatments (N=86) and judicially approved compulsory treatments (N=62) in 2015 and 2016 at 6 hospital locations in Baden-Württemberg were retrospectively analysed.

Results: Patients had an average of 8 previous psychiatric hospitalisations with a cumulative duration of 645 days on average and 87% had a psychotic disorder.

Implementation of guidelines on prevention of coercion and violence (PreVCo) in psychiatry: a multicentre randomised controlled trial.

Background: Interventions to prevent the use of coercion in psychiatric hospitals have been summarized in the 2018 German Association for Psychiatry, Psychotherapy, and Psychosomatic's comprehensive guidelines. Twelve recommendations for implementation of these guideline on psychiatric wards have been deducted and their feasibility has been tested in a pilot study, using external implementation consultants as facilitators. The objective of the PreVCo study was to test their effect in a randomised clinical trial.

Implementation of guidelines on prevention of coercion and violence: baseline data of the randomized controlled PreVCo study.

Introduction: The PreVCo study examines whether a structured, operationalized implementation of guidelines to prevent coercion actually leads to fewer coercive measures on psychiatric wards. It is known from the literature that rates of coercive measures differ greatly between hospitals within a country. Studies on that topic also showed large Hawthorne effects.

[The German S3 guidelines on prevention of coercion and treatment of aggressive behavior: from evidence to consensus, from consensus to implementation].

The German S3 guidelines on prevention of coercion: prevention and therapy of aggressive behavior in adults (2018) are cross-sectional guidelines that in addition to medical scientific evidence also touch to a great extent on questions of ethics and law as well as organizational structures of the healthcare system. Accordingly, in addition to the research on evidence, the consensus process also had a strong weighting in the development of the recommendations. The appropriate participation of experts from various fields and their representation in the consensus group was therefore of central importance.

Open Doors by Fair Means: a quasi-experimental controlled study on the effects of an open-door policy on acute psychiatric wards.

Background: Psychiatric wards treating involuntarily admitted patients are traditionally locked to prevent absconding. However, on the basis of observational evidence, the necessity for locked units in psychiatric hospitals has increasingly been questioned. Updated Mental Health Laws in several Federal States of Germany legitimate involuntary commitment without generally locked doors.

[Monitoring of coercive measures and compulsory treatment in Germany].

Epidemiological registers on the burden of disease and adverse events (deaths, serious side effects, etc.) play an important role in the management, evaluation, and improvement of healthcare treatment for the population. This also applies to coercive measures in the psychiatric healthcare system.

[Documentation, Application and Efforts to Reduce Involuntary Admissions and Coercive Measures - Results from a Nationwide Study on Acute Psychiatric Hospitals in Germany].

Objective: This nationwide full census survey investigated the documentation status regarding involuntary admissions and coercive measures in psychiatric hospitals in Germany.

Methods: As part of the ZIPHER study, a questionnaire survey on the documentation, application and reduction of coercion was conducted ( = 147, response rate = 34.4 %).