Integrated Psychiatric Services Winterthur - Zurcher Unterland, P.O. Box 144, CH-8408, Winterthur, Switzerland.
Meilener Institute Zurich, Stockerstrasse 45, Zurich, CH-8002, Switzerland.
BMC Psychiatry. 2022 Jun 25;22(1):431. doi: 10.1186/s12888-022-04076-x.
Coercive measures continue to be an important topic in psychiatry. However, there is no proof of the effectiveness of the use of coercive measures, especially with suicidal people. For many years, attempts have been made to replace such measures with alternative noncoercive intervention options. This paper aims to clarify the situation of coercive measures, more precisely seclusions, in a general psychiatric hospital in Switzerland. It focuses on compulsory measures in patients with suicidal tendencies.
In this single-centre retrospective cohort study, we used routinely collected medical data and performed qualitative analyses of medical histories to examine whether alternative measures to seclusion had been offered and/or provided to patients who had been secluded solely because of suicidality. Patients were aged 18-65 years and had received inpatient treatment at one of five adult acute care units at a general psychiatric hospital in Switzerland between September 2016 and December 2019.
There were 5,935 inpatient treatment cases during the study period. Suicidality was rated as "acute" or "very high" at least once during the hospitalization in 219 (3.7%) cases. Of these, 60 were excluded from further analyses as they involved seclusion, but suicidality was not the exclusive indication for this measure. Coercive seclusion was imposed exclusively due to suicidality in 53 (33.3%) of the remaining 159 cases, whereas 106 (66.7%) cases were not secluded. The rates of seclusion among suicidal patients varied considerably between the hospital wards (13.0% to 55.3%). Suicidal patients with non-Swiss residence status and/or lacking language skills were particularly prone to be secluded. Additionally, alternative interventions were offered and provided significantly more frequently in the nonsecluded patients.
To avoid seclusion due to suicidal tendencies, it is necessary to have a general attitude of avoiding coercive measures at all costs. It is also important for qualified staff to be able to deal with challenging sociodemographic characteristics of patients such as foreign-language, which may require translators and intercultural interpreters.
强制性措施在精神病学中仍是一个重要话题。然而，目前尚无证据表明使用强制性措施的有效性，尤其是对于有自杀倾向的人。多年来，人们一直试图用替代的非强制性干预措施来取代这些措施。本文旨在阐明瑞士一家综合精神病院的强制性措施（更确切地说是隔离）情况。它重点关注有自杀倾向的患者的强制性措施。
在这项单中心回顾性队列研究中，我们使用常规收集的医疗数据并对病历进行定性分析，以检查是否为仅因自杀而被隔离的患者提供了替代隔离的措施。患者年龄在 18-65 岁之间，于 2016 年 9 月至 2019 年 12 月期间在瑞士一家综合精神病院的五家成人急性护理病房之一接受住院治疗。
在研究期间，有 5935 例住院治疗病例。在住院期间，有 219 例（3.7%）患者的自杀风险至少被评估为“急性”或“非常高”。其中，有 60 例因涉及隔离而被排除在进一步分析之外，但这并非实施该措施的唯一指征。在其余 159 例患者中，有 53 例（33.3%）因仅因自杀而被强制隔离，而 106 例（66.7%）患者未被隔离。在自杀患者中，不同病房的隔离率差异很大（13.0%-55.3%）。无瑞士居留身份和/或语言技能的自杀患者尤其容易被隔离。此外，在未被隔离的患者中，替代性干预措施的提供和实施频率明显更高。
为避免因自杀倾向而被隔离，必须采取不惜一切代价避免强制性措施的总体态度。合格的工作人员还必须能够应对患者具有挑战性的社会人口特征，例如外语，这可能需要翻译和跨文化口译。
