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[德国的强制措施与强制治疗监测]

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

作者信息

Steinert Tilman, Hirsch Sophie, Flammer Erich

机构信息

Klinik für Psychiatrie und Psychotherapie I, Universität Ulm (Weissenau), Ulm (Weissenau), Deutschland.

Zentren für Psychiatrie Südwürttemberg, Ravensburg, Weingartshofer Str. 2, 88214, Ravensburg, Deutschland.

出版信息

Nervenarzt. 2022 Nov;93(11):1105-1111. doi: 10.1007/s00115-022-01349-4. Epub 2022 Jul 12.

Abstract

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. Such registers only became feasible on a broad basis due to the availability of electronic medical records and steadily increasing computing capacities; however, in most German states, registers have not been implemented. Data protection problems must be taken into account in the collation of person-related data but can be solved by appropriate pseudonymization procedures taking the prerequisites of data parsimony into account. Extensive data are now available from the Baden-Wuerttemberg register for coercive measures, which has been in existence since 2015 and which enabled, for instance, evaluating the consequences of the changes to the law following the 2018 ruling of the Federal Constitutional Court on mechanical restraint and the consequences of the coronavirus pandemic. In the meantime, there are also state-wide data collections in some other German states; however, unlike in Baden-Wuerttemberg, these registers do not include measures under guardianship law. A nationwide register for coercive measures, compulsory treatment and involuntary detention has justifiably repeatedly been demanded for a long time. A major obstacle is the historically developed separation between the responsibility of the German states for the detention regulated by public law and the Federal State for the scope of application of the guardianship law.

摘要

关于疾病负担和不良事件(死亡、严重副作用等)的流行病学登记册在人群医疗保健治疗的管理、评估和改进中发挥着重要作用。这也适用于精神科医疗保健系统中的强制措施。由于电子病历的可用性和计算能力的不断提高,此类登记册才在广泛基础上变得可行;然而,在德国大多数州,登记册尚未实施。在整理与个人相关的数据时必须考虑数据保护问题,但可以通过适当的假名化程序并考虑数据简约的前提条件来解决。现在可以从巴登-符腾堡州的强制措施登记册中获得大量数据,该登记册自2015年以来一直存在,例如,它能够评估联邦宪法法院2018年关于机械约束的裁决后法律变更的后果以及新冠疫情的后果。与此同时,德国其他一些州也有全州范围的数据收集;然而,与巴登-符腾堡州不同的是,这些登记册不包括监护法规定的措施。长期以来,人们一直合理地反复要求建立一个全国性的强制措施、强制治疗和非自愿拘留登记册。一个主要障碍是历史上形成的德国各州对受公法监管的拘留的责任与联邦政府对监护法适用范围的责任之间的分离。

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