Definition and use of coercive measures in old age psychiatry settings in Germany and Wales

Kronstorfer, Rita
January 2007
BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1
Academic Journal
Conference Paper
Background Patients with organic mental disorders (ICD 10 F0) are a high risk group in regard to being subject to coercive measures. Methods used in old age psychiatry tend to vary widely among European countries. Legal background, ethical considerations, staffing levels and techniques available in everyday practice are compared between two hospital settings in Germany and Wales. Implications of these on key outcome measures on the use of coercion in this patient group are discussed. Methods Coercive treatment was closely monitored in the German hospital setting. The recorded data on the use of restraints included length, duration, frequency and proportion of patients affected in each diagnostic group. In Wales similar data on the use of control and restraint techniques was documented for patients with a F0 diagnosis. Staffing levels were also compared for both settings. Results The methods of restraint used in both settings were very different, mostly due to legal implications and differences in ethical views. The proportions of patients subject to restraint were similar; however the length of the coercive measures seemed to depend on the method used. Holding techniques in Wales were associated with shorter duration compared to the use of mechanical restraint (belts) in Germany. In Wales twice as many nursing staff were available per occupied bed, which could also have influenced the use of restraint. In Germany, a reduction in the use of coercion over the years was noted, proving that staff training and attitude also play a crucial role. Conclusion Ethical and legal considerations, as well as available resources, have an impact on the use of coercive measures in patients with an organic mental health problem. Reflecting and monitoring local practice can lead to changes in staff's attitude and help to prevent the use of coercion. Even with high staffing levels, the use of coercion is still necessary in some cases to control aggression.


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