Zeitgemäß oder anachronistisch? Zwangseinweisungspraxis in Frankfurt am Main

Background: The evaluation of local mental health care remains difficult. For this reason systematic development of appropriate services is barely possible. Methods: We examined involuntary hospitalization in the city of Frankfurt/Main with regard to diagnoses, socio-demographic data, complementary psychosocial outpatient care, and circumstances of hospitalization. There are four psychiatric clinics, each serving a catchment area of more than 165.000 inhabitants. These clinics are responsible for all psychiatric in-patient treatments regardless of the admission modus. During a one year period, 677 patients were involuntarily hospitalized. Statistical analyses were performed subsequent to pooling the data. Results: During a period of one year, 103 out of 100.000 inhabitants of Frankfurt/Main were admitted involuntarily. The rate of involuntary admissions related to all admissions was 10.98 percent. Any complementary psychosocial care was missing in more than 70 percent of patients admitted involuntarily. Only about 10 percent of patients were examined by a physician before reaching the hospital and in disappointing 1.3 percent the municipal mental health service had been consulted prior to involuntarily admission. Conclusion: Our results show that a systematic improvement of precautionary complementary psychosocial care for risk patients is needed as well as the obligation of psychiatric emergency consultation before involuntary hospitalization.Anliegen: In der gemeindepsychiatrischen Versorgung ist eine systematische Datenerhebung bislang unzureichend etabliert. Daher ist eine planvolle Entwicklung von Versorgungsstrukturen kaum möglich. Zur weiteren Qualitätsverbesserung der gemeindepsychiatrischen Struktur soll eine verlässliche Datenbasis geschaffen werden. Methode: Das durch den Sozialpsychiatrischen Dienst initiierte Projekt PISA untersuchte 677 Zwangseinweisungen in die Versorgungskliniken der Stadt Frankfurt/Main. Ergebnisse: Bei über 70 % der Patienten fehlte eine komplementäre psychosoziale Versorgung, nur 10 % wurden außerhalb der Klinik vor der Einweisung ärztlich untersucht, nur 1,3 % durch den Sozialpsychiatrischen Dienst. Schlussfolgerungen: Eine gezielte Ausweitung ambulanter Hilfesysteme und die Hinzuziehung fachärztlicher Kompetenz vor einer Zwangseinweisung erscheinen dringend erforderlich

Involuntary hospitalizations in Frankfurt/Main, Germany

Background: The evaluation of local mental health care remains difficult. For this reason systematic development of appropriate services is barely possible. Methods: We examined involuntary hospitalization in the city of Frankfurt/Main with regard to diagnoses, socio-demographic data, complementary psychosocial outpatient care, and circumstances of hospitalization. There are four psychiatric clinics, each serving a catchment area of more than 165.000 inhabitants. These clinics are responsible for all psychiatric in-patient treatments regardless of the admission modus. During a one year period, 677 patients were involuntarily hospitalized. Statistical analyses were performed subsequent to pooling the data. Results: During a period of one year, 103 out of 100.000 inhabitants of Frankfurt/Main were admitted involuntarily. The rate of involuntary admissions related to all admissions was 10.98 percent. Any complementary psychosocial care was missing in more than 70 percent of patients admitted involuntarily. Only about 10 percent of patients were examined by a physician before reaching the hospital and in disappointing 1.3 percent the municipal mental health service had been consulted prior to involuntarily admission. Conclusion: Our results show that a systematic improvement of precautionary complementary psychosocial care for risk patients is needed as well as the obligation of psychiatric emergency consultation before involuntary hospitalization.Anliegen: In der gemeindepsychiatrischen Versorgung ist eine systematische Datenerhebung bislang unzureichend etabliert. Daher ist eine planvolle Entwicklung von Versorgungsstrukturen kaum möglich. Zur weiteren Qualitätsverbesserung der gemeindepsychiatrischen Struktur soll eine verlässliche Datenbasis geschaffen werden. Methode: Das durch den Sozialpsychiatrischen Dienst initiierte Projekt PISA untersuchte 677 Zwangseinweisungen in die Versorgungskliniken der Stadt Frankfurt/Main. Ergebnisse: Bei über 70 % der Patienten fehlte eine komplementäre psychosoziale Versorgung, nur 10 % wurden außerhalb der Klinik vor der Einweisung ärztlich untersucht, nur 1,3 % durch den Sozialpsychiatrischen Dienst. Schlussfolgerungen: Eine gezielte Ausweitung ambulanter Hilfesysteme und die Hinzuziehung fachärztlicher Kompetenz vor einer Zwangseinweisung erscheinen dringend erforderlich