The use of mechanical restraint and seclusion in patients with schizophrenia: A comparison of the practice in Germany and Switzerland

BACKGROUND: The use of coercive measures is an indicator of the quality of psychiatric inpatient treatment. To date, there is no data available to European comparisons on the incidence of such measures. METHODS: The frequency and duration of mechanical restraint and seclusion on patients with a diagnosis of F2 ICD-10 was analysed in seven German and seven Swiss psychiatric hospitals in the year 2004 using three indicators. Differences between German and Swiss hospitals regarding the indicators were tested for statistical significance using Mann-Whitney-U-tests. RESULTS: 6.6 % (Switzerland) and 10.4 % (Germany) of admissions respectively were affected by mechanical restraint and 17.8 % (Switzerland) and 7.8 % (Germany) respectively by seclusion. Seclusion as well as mechanical restraint per case were applied significantly more often in German than in Swiss hospitals and were of significantly longer duration in Swiss than in German hospitals. CONCLUSION: The results showed different patterns in the use of seclusion and mechanical restraint across Swiss and German hospitals. For future European research on the use of compulsory measures in routine psychiatric care, there is a need for uniformed definitions, reliable documentation of coercive measures as well as for an identical way of data analysis. To meet these conditions is the first step to achieve European standards for the use of coercive measures

Longitudinal Patterns of Suicidality Among Heroin Users in Johannesburg, South Africa: A Need for Suicide Screening and Intervention

Objectives: The objective of the study was to longitudinally assess the outcomes and correlates of suicidal ideation and behavior (SIB) among heroin users who attended inpatient detoxification and psychosocial rehabilitation. SIB was assessed in 300 heroin users upon entry into inpatient detoxification (baseline) as well as 3-months (t1) (n = 252; 84%) and 9-months (t2) (n = 225; 75%) post treatment. Multivariable logistic regression was used to determine the demographic, clinical and treatment related factors that increased the risk for a high SIB score. Results: From baseline to t1 there was a significant decrease in the proportion of those who endorsed SIB (68.7 vs. 38.9%, p \u3c 0.0001). There was an increase in the proportion of those who endorsed SIB from t1 to t2 (38,9 vs. 47.1%, p = 0.047). There was a significant increase in the proportion of those reporting suicide likely in the near future from baseline to t1 (8.7 vs. 16.3%: p \u3c 0.0049) and this was repeated from t1 to t2 (22.7%) (t1 vs. t2: p = 0.031). After controlling for all other variables, a comorbid mental illness (MI) at baseline was a significant independent risk factor for a high SIB score at t1(RR 1.63; 95% CL 1.30–2.03) (p \u3c 0.0001) and a comorbid MI at t1 increased the risk for a high SIB score at t2 (RR 2.73; 95% CL 1.78–4.19) (p \u3c 0.0001). A poorer general health score and poorer social functioning score at baseline were associated with a high SIB score at baseline (RR 1.02; 95% CL 1.01–1.04) (p = 0.001) and t2, respectively (RR 1.07; 95% CL 1.04–1.11) (p \u3c 0.0001). Conclusions: Among heroin users, a comorbid mental illness, poorer physical health and poorer social functioning are important factors to consider in suicide risk assessment. Although there were decreases in overall SIB 3 months after detoxification, this trend was not sustained at 9-month follow-up. After detoxification there were significant increases in the proportion of those reporting a likelihood of suicide in the following 3 months. The results suggests that the treatment exposure did not adequately mitigate suicide risk. There is a need for review of the treatment as well as targeted screening and management of SIB in heroin users attending treatment services

International variations in mental-health law regulating involuntary commitment of psychiatric patients as measured by the Mental Health Legislation Attitudes Scale

Previous research illustrated that the laws regulating involuntary placement and treatment of people with mental-health problems are diverse across countries. International studies comparing satisfaction levels between countries are rare. We compared the opinions of professionals and family members about the operation of the national mental-health law regulating forcibly admission and treatment of psychiatric patients in 11 countries: Ireland, Iceland, England and Wales, Romania, Slovenia, Denmark, Germany, Sweden, Norway and India. An online survey design was adopted using a Mental Health Legislation Attitudes Scale (MHLAS). This brief nine-item questionnaire was distributed via email to psychiatrists, general practitioners, acute and community mental-health nurses, tribunal members, police officers and family members in each collaborating country. The levels of agreement/disagreement were measured on a Likert scale. Data were analysed both per question and with regard to a total MHLAS ‘approval’ score computed as a sum of the nine questions. We found that respondents in England and Wales and Denmark expressed the highest approval for their national legislation (76% and 74%, respectively), with those in India and Ireland expressing the lowest approval (65% and 64%, respectively). Almost all countries had a more positive attitude in comparison to Ireland on the admission criteria for involuntary placement and the way people are transferred to psychiatric hospitals. There are significant variations across Europe and beyond in terms of approval for how the national mental-health law framework operates in each country

Needs-oriented discharge planning and monitoring for high utilisers of psychiatric services (NODPAM): Design and methods

<p>Abstract</p> <p>Background</p> <p>Attempts to reduce high utilisation of psychiatric inpatient care by targeting the critical time of hospital discharge have been rare.</p> <p>Methods</p> <p>This paper presents design and methods of the study "Effectiveness and Cost-Effectiveness of Needs-Oriented Discharge Planning and Monitoring for High Utilisers of Psychiatric Services" (NODPAM), a multicentre RCT conducted in five psychiatric hospitals in Germany. Inclusion criteria are receipt of inpatient psychiatric care, adult age, diagnosis of schizophrenia or affective disorder, defined high utilisation of psychiatric care during two years prior to the current admission, and given informed consent. Consecutive recruitment started in April 2006. Since then, during a period of 18 months, comprehensive outcome data of 490 participants is being collected at baseline and during three follow-up measurement points.</p> <p>The manualised intervention applies principles of needs-led care and focuses on the inpatient-outpatient transition. A trained intervention worker provides two intervention sessions: (a) Discharge planning: Just before discharge with the patient and responsible clinician at the inpatient service; (b) Monitoring: Three months after discharge with the patient and outpatient clinician. A written treatment plan is signed by all participants after each session.</p> <p>Primary endpoints are whether participants in the intervention group will show fewer hospital days and readmissions to hospital. Secondary endpoints are better compliance with aftercare, better clinical outcome and quality of life, as well as cost-effectiveness and cost-utility.</p> <p>Discussion</p> <p>If a needs-oriented discharge planning and monitoring proves to be successful in this RCT, a tool will be at hand to improve patient outcome and reduce costs via harmonising fragmented mental health service provision.</p> <p>Trial Registration</p> <p>ISRCTN59603527</p