Association between restriction of involuntary medication and frequency of coercive measures and violent incidents

Abstract

Objective: In theGerman federal state of Baden-Wuerttemberg involuntary medication of psychiatric inpatients was illega during eight months from July 2012 until February 2013. Th authors examined whether the number and duration of mechanica coercive measures (seclusion and restraint) and th number and severity of violent incidents changed in this period Methods: A cross-sectional analysis was conducted o admission-related routine data collected in seven psychiatri hospitals in three time periods (period 1, July 2011-Februar 2012; period 2, July 2012-February 2013; and period 3, Jul 2013-February 2014). All patients with psychotic disorder and at least one admission during at least one of the thre time periods were included (N52,071), for a total of 3,48 admissions Results: The mean number ofmechanical coercivemeasure and violent incidents per admission increased significantl during period 2, when involuntary medication was not possible and decreased significantly during period 3. They als differed significantly between periods 1 and 3. The percentag of admissions involving seclusion increased during perio 2 significantly and was significantly different during perio 1 comparedwith period 3. The severity of illness and the lengt of hospitalization did not change over the three periods Conclusions: Restriction of involuntary medication was associate with a significant increase in use of mechanica coercive measures and violent incidents.