Introduction
In Baden-Wuerttemberg, supplying data on coercive measures to a central register has been mandatory since 2015. We introduce the central register, show which data is collected and how it can be used for benchmarking and to answer research questions. We present data for the years 2015-2022 and answer two questions:
(1) What influence does a mandatory judicial authorization for mechanical restraint in 2018 have on the frequency of coercive measures?
(2) Was the Covid-19 pandemic in 2020 associated with changes in the percentage of patients exposed to coercive interventions?
Methods
Data for the years 2015-2022 were analyzed calculating:
(a) The proportion of cases with coercive measures.
(b) The proportion of cases with involuntary placements.
(c) The cumulative duration of coercive measures per affected case.
Results
(1) The percentage of patients subjected to any kind of freedom-restricting coercion (restraint or seclusion) decreased from 6.7 (average 2015-2017) to 5.8 in 2019 (p < 0.001). Following the mandatory judicial authorization for mechanical restraint, the percentage of patients subjected to such measure decreased from 4.8 to 3.6% in 2019 and the percentage of patients subjected to seclusion increased from 2.9 to 3.3%. The median cumulated duration of restraint and seclusion per affected case decreased from 12.7h to 10.9h.
(2) From 2019 to 2020 (year most affected by the pandemic) the number of cases in adult psychiatry decreased by 7.6%. The percentage of involuntary cases increased from 12.3 to 14.1%, and the number of coercive measures increased by 4.7%. The percentage of cases exposed to any kind of coercive measure increased by 24.6% from 6.5 to 8.1%.
Discussion & Conclusion
The register allows a complete survey and longitudinal comparisons. Causal relationships are not possible without a control group and when using aggregated routine data, so the results must be interpreted with caution.