Department of Psychiatry, Psychotherapy and Preventive Medicine, LWL University Hospital, Ruhr University Bochum, Germany.
LWL-Institute of Mental Health, LWL University Hospital, Ruhr University Bochum, Germany.
Int J Law Psychiatry. 2020 Jul-Aug;71:101597. doi: 10.1016/j.ijlp.2020.101597. Epub 2020 Jun 22.
The present study aimed to characterize involuntary psychiatric admissions and coercive measures within psychiatric hospitals regarding their temporal development and processual aspects. Moreover, the influence of socio-economic factors on involuntary admissions and coercive measures was investigated.
Different data sets from the federal state of North-Rhine Westphalia (NRW) were used in this study. In addition to a survey in which n = 33 hospitals responded (40.7%), official data from the Federal Health Ministry were analysed over a decade regarding involuntary admissions and coercive measures. These data were available for all n = 54 districts, respectively, all n = 81 psychiatric hospitals in NRW. Datasets were mainly analysed comparing different socio-economic clusters.
The hospital admission rate increased significantly over time (from 1.12 to 1.34 per 1000 inhabitants) within ten years. However, whereas the admission rates differed significantly between socio-economic clusters, the amount of coercive measures used in the hospitals did not. Compared to general psychiatry and addiction medicine, geriatric psychiatry had the highest amount of involuntary admissions (12.2% under public law, 14.1% under civil law). Furthermore, most coercive measures lasted at least an hour.
It seems that, despite intense discussions and enhanced efforts to reduce coercion, there are still some neglected aspects, such as the need for coercive measures and their duration, particularly in the geriatric psychiatric setting. In addition, the results show that further approaches to prevent involuntary admissions are needed to address other stakeholders beyond the hospitals and further aspects of the socio-economic environment.
本研究旨在描述精神病院非自愿入院和强制治疗的时间发展和程序方面的特征。此外，还调查了社会经济因素对非自愿入院和强制治疗的影响。
本研究使用了来自北莱茵-威斯特法伦州（NRW）的不同数据集。除了对 33 家医院（占 40.7%）进行了一项调查外，还对联邦卫生部在过去十年中关于非自愿入院和强制治疗的官方数据进行了分析。这些数据可用于 NRW 的所有 54 个区和 81 家精神病院。数据集主要通过比较不同的社会经济群体进行分析。
在十年内，医院入院率呈显著上升趋势（从每 1000 居民 1.12 人增加到 1.34 人）。然而，尽管社会经济群体之间的入院率存在显著差异，但医院使用的强制治疗措施数量却没有差异。与普通精神病学和成瘾医学相比，老年精神病学的非自愿入院率最高（公立法为 12.2%，民法为 14.1%）。此外，大多数强制治疗措施至少持续一小时。
尽管进行了激烈的讨论和加强努力以减少强制治疗，但仍存在一些被忽视的方面，例如对强制治疗的需求及其持续时间，特别是在老年精神病学领域。此外，研究结果表明，需要采取进一步的方法来预防非自愿入院，以解决医院以外的其他利益相关者和社会经济环境的其他方面的问题。
