Increase in coercive measures in psychiatric hospitals in Germany during the COVID-19 pandemic

• Published in: PloS one 2022-08, Vol.17 (8), p.e0264046
• Main Authors: Flammer, Erich, Eisele, Frank, Hirsch, Sophie, Steinert, Tilman
• Format: Article
• Language: English
• Subjects: Aggressiveness; Biology and Life Sciences; Coercivity; Complications and side effects; Constraints; Coronaviruses; COVID-19; Data integrity; Exposure; Guardians; Hospitals; Infections; International organizations; Intervention; Isolation (Hospital care); Medicine and Health Sciences; Mental disorders; Mental health; Pandemics; Patients; People and places; Prevention; Privacy; Psychiatric hospital care; Psychiatric hospitals; Psychiatry; Safety and security measures; Social Sciences; Society
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0264046

To examine whether the pandemic in 2020 caused changes in psychiatric hospital cases, the percentage of patients exposed to coercive interventions, and aggressive incidents. We used the case registry for coercive measures of the State of Baden-Wuerttemberg, comprising case-related data on mechanical restraint, seclusion, physical restraint, and forced medication in each of the State's 31 licensed hospitals treating adults, to compare data from 2019 and 2020. The number of cases in adult psychiatry decreased by 7.6% from 105,782 to 97,761. The percentage of involuntary cases increased from 12.3 to 14.1%, and the absolute number of coercive measures increased by 4.7% from 26,269 to 27,514. The percentage of cases exposed to any kind of coercive measure increased by 24.6% from 6.5 to 8.1%, and the median cumulative duration per affected case increased by 13.1% from 12.2 to 13.8 hrs, where seclusion increased more than mechanical restraint. The percentage of patients with aggressive incidents, collected in 10 hospitals, remained unchanged. While voluntary cases decreased considerably during the pandemic, involuntary cases increased slightly. However, the increased percentage of patients exposed to coercion is not only due to a decreased percentage of voluntary patients, as the duration of coercive measures per case also increased. The changes that indicate deterioration in treatment quality were probably caused by the multitude of measures to manage the pandemic. The focus of attention and internal rules as well have shifted from prevention of coercion to prevention of infection.