Overcoming the lack of alternatives - Changes in the use of coercive measures after implementation of the recovery-oriented "Weddinger Modell" in acute psychiatric care.

Introduction: Due to the ethical conflict potential and far-reaching negative consequences of coercive measures (CM) in acute psychiatry, approaches to reduce the use of CM are investigated increasingly. One approach is the recovery-, resilience-, and patient-centered "Weddinger Modell" (WM) for inpatient psychiatric care. The present study evaluates the WM and investigates whether cases affected by CM, cases affected by seclusion or restraint, and the number, total duration, and average individual duration of CM per case are significantly reduced after WM-implementation.

Children and adolescents at risk for seclusion and restraint in inpatient psychiatric treatment: a case control study.

Unlabelled: To reduce coercion in acute inpatient child and adolescent psychiatric units, a better understanding of individuals at risk for seclusion and/or restraint (S/R) is needed. We report data on the proportion of patients secluded/restrained and factors associated with higher risk of S/R. Identifying preventative mechanisms through risk stratification upon inpatient admission can aid the training of mental health professionals, and support shaping specific workflows for at-risk populations for example by joint crisis plans or post-coercion review sessions.

Relationship between perceived coercion and perceived justification of coercive measures - secondary analysis of a randomized-controlled trial.

Background: Subjective perception of coercion has gained attention as an important outcome. However, little is known about its relation to patients' appraisal of the justification of coercive measures. The present study aims to analyze the relationship between patients' appraisal of the justification of coercive measures and their level of perceived coercion.

Coercive measures in psychiatry - When do they occur and who is at risk?

Coercive measures (CM) in psychiatry adversely affect patients and efforts to minimize CM are steadily increasing. One area that has not been a strong focus of preventative efforts to date is the time of use of CM during hospitalization although previous research indicates that the admission situation and early hospitalization are times of increased risk for CM. This study therefore aims to contribute to the body of research in this field by analyzing in detail the times of use of CM and identifying patient characteristics serving as predictors for CM during early hospitalization.

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.

Patient communication ability as predictor of involuntary admission and coercive measures in psychiatric inpatient treatment.

Coercive measures (CM) and involuntary admission to psychiatric treatment can have detrimental consequences for patients. Past research shows that certain clinical, treatment and admission-related characteristics put patients at a higher risk of experiencing CM and involuntary admission. Although of high societal importance, the association between patients' communication ability and CM and involuntary admission has not been subject of past research.

Effects of Recovery-Orientation on the Use of Forced Medication and Maximum Daily Drug Dose: The "Weddinger Modell".

The aim of the present study was to analyze the effects of the implementation of the Recovery-orientated psychiatric care concept "Weddinger Modell" on the incidence of forced medication, the total number of forced medication incidents per affected case, the maximum dose of a singular forced medication and the maximum voluntary daily drug dose of different psychotropic drugs administered during an inpatient stay. This retrospective case-control study included 234 patients. A pre/post-comparison of patients on two acute psychiatric wards before (control group, = 112) and after (intervention group, = 122) the implementation of the Weddinger Modell in 2010 was performed.

Effect of standardized post-coercion review on subjective coercion: Results of a randomized-controlled trial.

Background: Post-coercion review has been increasingly regarded as a useful intervention in psychiatric inpatient setting. However, little is known about its effect on perceived coercion.

Methods: A multicenter, two-armed, randomized controlled trial was conducted, aiming at analyzing the effect of post-coercion review on perceived coercion.

The Role of Implicit and Explicit Staff Attitudes in the Use of Coercive Measures in Psychiatry.

Many determinants leading to the use of different coercive measures in psychiatry have been widely studied and it seems that staff attitudes play a crucial role when it comes to the decision-making process about using coercion. However, research results about staff attitudes and their role in the use of coercive measures are inconsistent. This might be due to a focus on self-report studies asking for explicit answers, which involves the risk of bias.