Matthias Jäger

University of Zurich | UZH · Department for Psychiatry, Psychotherapy and Psychosomatics

Background Coercive measures (such as seclusion, mechanical restraint, and forced medication) during psychiatric inpatient treatment should be avoided whenever possible. Different interventions were already developed to reduce coercion, but for their effective application, it is crucial to know the risk factors of individuals and clinical situation...

Background No randomised controlled study (RCT) on the effectiveness of Independent Supported Housing (ISH) vs. housing as usual (HAU) settings for non-homeless individuals with severe mental illness (SMI) has been conducted to date because of limited feasibility. Alternative designs, such as observational studies, might be suitable for providing a...

Despite widespread support for Independent Supported Housing (ISH) interventions, psychiatric housing rehabilitation still commonly takes place in residential care facilities (RCFs). This study compares preferences, attitudes and working conditions of mental healthcare professionals (MHCPs) in ISH and RCFs using an online survey. The survey include...

Objectives: Small area analysis is a health services research technique that facilitates geographical comparison of services supply and utilization rates between health service areas (HSAs). HSAs are functionally relevant regions around medical facilities within which most residents undergo treatment. We aimed to identify HSAs for psychiatric outp...

Background. No randomised controlled study (RCT) on the effectiveness of various housing settings for non-homeless individuals with severe mental illness (SMI) has been conducted to date. Alternative designs, such as observational studies, might be suitable for providing adequate evidence if well conducted. To test this hypothesis, this article rep...

Background Independent supported housing (ISH)—services to support independent housing are recommended by current guidelines. However, there is little evidence of ISH models for non-homeless people with severe mental illness (SMI). The aim of this study was to examine the effectiveness of ISH by comparing the clinical outcomes of a newly implemente...

Psychiatric emergencies occur frequently in the community setting, e.g. the patient’s home or public places. Little is known about the characteristics and outcome of these situations. This study describes psychiatric emergencies in the canton of Zurich, Switzerland, and examines determinants of their outcome. We retrospectively analyzed 620 medical...

Die Thematik des Wohnens in der psychiatrischen Versorgung hat in den letzten Jahren einen erheblichen Aufschwung in der Forschung erfahren. Der Beitrag gibt einen Überblick über den aktuellen Forschungsstand. Thematisiert werden zunächst die besonderen methodischen Herausforderungen der Wohnforschung. Bezüglich der Wohnformen hat sich das unabhäng...

Home treatment (HT) has been proposed as an alternative to inpatient treatment for individuals in acute mental crises. However, there is limited evidence concerning the effectiveness of HT to date. The aim of this study was to investigate which patients benefit most from HT. The concept and utilization of two HT services in Switzerland were retrosp...

ZUSAMMENFASSUNG Die Behandlung von Menschen mit psychotischen Störungen erfordert ein eng abgestimmtes Vorgehen von Fachpersonen verschiedener Professionen, um die vielfältigen medizinischen, psychologischen und sozialen Dimensionen zu berücksichtigen, die durch die Erkrankung betroffen sein können. Interprofessionelle Zusammenarbeit (IPZ) geht deu...

Background: Healthcare professionals can be a source of stigma and discrimination for people with mental illness, and anti-stigma programs are needed for this target group. However, there is no validated German language scale to assess attitudes of healthcare professionals towards people with mental illness. This study had the aim to validate the...

Die Idee, dass nach der klassischen Psychiatrie nun eine Postpsychiatrie folgt, die auf anderen Grundlagen und aus einer anderen Perspektive heraus tätig wird, wird seit einigen Jahren nicht nur im deutschsprachigen, sondern auch im englischsprachigen Raum diskutiert (Bracken, Thomas 2001). Der Artikel stellt die Hypothese auf, dass wir längst in d...

Background: Healthcare professionals can be a source of stigma and discrimination for people with mental illness, and anti-stigma programs are needed for this target group. However, there is no validated German language scale to assess attitudes of healthcare professionals towards people with mental illness. This study had the aim to validate the G...

The Covid-19 pandemic has challenged the Swiss mental health care system. Many services were downsized or closed and admission to treatment and care institutions was restricted during lockdown. While these measures were necessary according to the general containment and mitigation strategies of federal and cantonal authorities, this situation has h...

Background In line with previous findings, in a recent randomized controlled trial (RCT), we found that home treatment (HT) for acute mental health care can reduce (substitute) hospital use among severely ill patients in crises. This study examined whether the findings of the RCT generalize to HT services provided under routine care conditions. Me...

Background Eating disorders (ED) and disordered eating (DE) among male elite athletes share some of the characteristics seen in female elite athletes and the population, but also exhibit some key differences. Objective Scoping review of ED and DE in male elite athletes. Methods In May 2020, a comprehensive systematic literature search was conduct...

Background Home treatment (HT) has been proposed as a patient-centred alternative to acute mental inpatient care although evidence of patient-reported outcomes has remained limited. Aims The aim of this study was to examine patient experiences and satisfaction with HT. Methods This retrospective mixed-methods study included telephone interviews o...

Background: Social inclusion is essential for an adequate rehabilitation process for people with serious mental illness (SMI). Various supported housing settings aim to promote housing competencies and social inclusion in service users. Nevertheless, there is a strong preference in service users for independent living. We aim to evaluate the effec...

Zusammenfassung Ziel der Studie Untersuchung der Haltung gegenüber somatischen und psychiatrischen Patientenverfügungen (PPV) in der deutschsprachigen Schweiz. Methodik Fragebogenerhebung bei Psychiatriepatienten, Psychiatern, Psychologen, Pflegefachpersonen und Peers anhand von drei Fallbeispielen. Ergebnisse Die Haltung gegenüber Patientenverfügu...

Background: The therapeutic relationship and its importance for psychotherapy outcome have been the subject of extensive research over the last decades. An acute psychiatric inpatient setting is a unique environment where severely ill patients receive intensive treatment over a limited, relatively short, period of time. This renders establishing a...

Selbstbestimmtes Wohnen als Reformziel des BTHG 2020 werden die Leistungen der Eingliederungshilfe in den zweiten Teil des Rehabilitationsgesetzes für Menschen mit Behinderung SGB IX überführt. Getrennt von den existenzsichernden Leistungen werden sie dann als Assistenzleistungen für das selbstbestimmte und eigenverantwortliche Wohnen sowie in beso...

The use of coercion poses a key concern in terms of patients’ rights. To reduce coercive interventions, a change in the attitudes of mental health professionals toward coercion has been proposed. This study examined whether individual and workplace characteristics are associated with attitudes toward coercion. A sample of 110 staff members of a lar...

Background Psychiatric advance directives (PAD) were shown to be effective in the reduction of coercion and strengthening of the patients` autonomy. Therefore, the Swiss legislation was revised and stipulates that PAD must be taken into account during involuntary hospitalization. This study aimed to analyze knowledge on and attitudes towards this i...

Stigmatization towards individuals with mental illness is common among mental healthcare professionals, yet poses a key concern regarding the provision of effective support and therapy for those undergoing psychiatric treatment. In this study, we examined to what extent recovery attitudes among mental healthcare professionals are associated with st...

Background Involuntary admissions can be detrimental for patients. Due to legal, ethical and clinical considerations, they are also challenging for referring physicians. Nevertheless, not much is known about the subjective perceptions of those who have to decide whether to conduct an involuntary admission or not. Aims This study aimed at answering...

Seit den 1990er-Jahren fand im Rahmen der Deinstitutionalisierung und Schliessung von Langzeitabteilungen in der Psychiatrie eine Verlegung von Langzeitpatientinnen und -patien­ten in betreute Wohnformen statt. Im Bereich der Wohninstitutionen mit geschlossen geführten Abteilungen für Menschen mit einer psychischen Erkrankung übersteigt in der Deut...

Background: Involuntary admission (IA) for psychiatric treatment has a history of controversial discussions. We aimed to describe characteristics of a cohort of involuntarily compared to voluntarily admitted patients regarding clinical and socio-demographic characteristics before and after implementation of the new legislation. Methods: In this...

Background: In psychiatric treatment containment measures are used to de-escalate high-risk situations. These measures can be characterized by their immanent amount of coercion. Previous research could show that the attitudes towards different containment measures vary throughout countries. The aim of this study was to compare the attitudes toward...

Background: Involuntary admission (IA) for psychiatric treatment is a massive restriction of human rights. Therefore, its execution is regulated by law. During executing IAs referring physicians find themselves in a dual role: support of patients in the recovery process but also safe-keeper of society. In Zurich, Switzerland the law stipulates tha...

Introduction: Involuntary admissions to psychiatric hospitals, regardless of their beneficial effects, violate the patients' autonomy. To keep such measures at a minimum and develop less restricting and coercive alternatives, a better understanding of the psychiatric emergency situations which end up in involuntary admissions is needed. This descri...

Unterstützte Entscheidungsfindung Bei der Behandlung von psychischen Erkrankungen sind viele Entscheidungen zu treffen. Nicht selten wird dabei Zwang ausgeübt. Spätestens seit der Ratifizierung der UN-Behindertenrechtskonvention sollen Behandelnde, Betreuende und Angehörige jedoch nicht mehr stellvertretend für psychisch erkrankte Menschen entschei...

Treatment guidelines recommend home treatment (HT) as an effective alternative to inpatient treatment for individuals with severe, acute mental illness (SAMI). Nevertheless, HT is largely unfamiliar in German-speaking countries. Here we examined the utilization and effectiveness of HT services newly implemented in a large hospital setting in Switze...

Background: In clinical psychiatric practice, health care professionals (HCP) must decide in exceptional circumstances after the weighing of interests, which, if any, containment measures including coercion are to be used. Here, the risk for patients, staff, and third parties, in addition to therapeutic considerations, factor into the decision. Pat...

Introduction: Although knowledge about negative effects of coercive measures in psychiatry exists, its prevalence is still high in clinical routine. This study aimed at define risk factors and test machine learning algorithms for their accuracy in the prediction of the risk to being subjected to coercive measures. Methods: In a sample of involuntar...

Psychotherapy of psychotic disorders Abstract. The efficacy of psychotherapy for individuals with psychotic disorders is well documented and its implementation is recommended by international guidelines. Goals of psychotherapeutic interventions are reduction of symptoms, prevention of relapse, improvement of cognitive, emotional and social function...

Involuntary hospitalization is a frequently discussed intervention physicians must sometimes execute. Because this intervention has serious implications for the citizens' civil liberties it is regulated by law. Every country's health system approaches this issue differently with regard to the relevant laws and the logistical processes by which invo...

Objective: This paper investigates the subjective needs of psychiatric patients in relation to the housing conditions with an additional focus on inclusion and participation. Furthermore, it examines differences in clinical and socio-demographic parameters, self-measured quality of life, stage of recovery. Methods: In this quantitative cross-sec...

Aims of the study: In daily clinical work, coercion continues to be highly prevalent, with rates differing between countries and sometimes even within countries or between wards of the same hospital. Previous research found inconsistent characteristics of individuals who underwent coercive measures during psychiatric treatment. Furthermore, there...

Although involuntary commitment (IC) is a serious intervention in psychiatry and must always be regarded as an emergency measure, the knowledge about influencing factors is limited. Aims were to test the hypothesis that duration of involuntary hospitalization and associated parameters differ for IC’s mandated by physicians with or with less routine...

Treatment pressure restricts patients' voluntary and autonomous decisions. Yet interventions involving treatment pressure are widely used in mental health and psychosocial services. This cross-sectional study explored whether mental health professionals' knowledge on five types of treatment pressure (no coercion, persuasion or conviction, leverage,...

Disturbed Eating Behavior and Eating Disorders are among the most common mental health problems and diseases in high-performance sports. In addition to the classic eating disorders that are classified in ICD-10 and DSM-5 other phenotypes of disturbed eating behavior play an important role in high-performance sport. Sports-specific disturbed eating...

Aims: Informal coercion is a frequently used form of communication among mental health professionals to influence treatment outcomes. This study investigates the recognition, attitude, and application of different forms of informal coercion by mental health professionals. Methods: Mental health professionals of five psychiatric institutions in G...

Background: The night clinic which is part of the psychiatric department of the University of Zurich is a part-time treatment option with psychiatric treatment and support in the evening. This study aimed to characterize the patients and detect different functions of the treatment setting. Methods: Data of 253 patients covering a six-year period...

Rationale: An ongoing debate concerns acceptability, benefits, and shortcomings of coercive treatment such as assisted outpatient treatment (AOT). The hypothesis that involuntary commitment to outpatient treatment may lead to a better clinical outcome for a subgroup of persons with severe mental illness (SMI) is controversial. Nonetheless, positiv...

Zusammenfassung. Die therapeutische Beziehung ist nicht nur die Grundlage für die Vermittlung jeder medizinischen Behandlung, sondern selbst einer der wirksamsten Faktoren für den Therapieerfolg. Mit der Absicht, die Behandlungsbereitschaft und den Gesundheitszustand eines Patienten zu verbessern, wird im Rahmen der Arzt-Patienten-Beziehung häufig...

BACKGROUND: The night clinic which is part of the psychiatric department of the University of Zurich is a part-time treatment option with psychiatric treatment and support in the evening. This study aimed to characterize the patients and detect different functions of the treatment setting. METHODS: Data of 253 patients covering a six-year period fr...

Wohnung und Hilfen zur Alltagsbewältigung unabhängig voneinander zu gewähren, ist seit der Einführung des Bundesteilhabegesetzes selbstverständlich. Das Handbuch führt in die neuen Rahmenbedingungen des Betreuten Wohnens ein. Die Vorstellung der dazugehörigen fachlichen Instrumente und Methoden der Alltagsbegleitung und der Wohnversorgung ist praxi...

Introduction Although informal coercion is frequently applied in psychiatry, its use is discussed controversially. This systematic review aimed to summarize literature on attitudes toward informal coercion, its prevalence, and clinical effects. Methods A systematic search of PubMed, Embase, PsycINF, and Google Scholar was conducted. Publications w...

Anliegen Untersuchung der psychiatrischen Morbidität und der subjektiven Gesundheit (self-rated health, SRH) bei Wohnungslosen in der Stadt Zürich. Methode Querschnittsstudie bei Wohnungslosen (n = 338) in Zürich und Vergleich der SRH mit jener der Allgemeinbevölkerung (n = 21 597). Ergebnisse Bei 96 % der Wohnungslosen lag mindestens eine psychiat...

Background The goal was to investigate the quality in terms of formal and content-based comprehensiveness of the forms for involuntary admission before and after the introduction of the new law (KESR, “Kindes- und Erwachsenenschutzrecht”) for the regulation of involuntary admission. Moreover, the study aimed at assessing if the quality of the admis...

Work is beneficial for the recovery from mental illness. Although the approach of individual placement and support (IPS) has been shown to be effective in Europe, it has not yet been widely implemented in European health care systems. The aim of this randomized controlled trial was to assess the effectiveness of IPS for disability pensioners with m...

Individuals with severe mental illness frequently have difficulties in obtaining and maintaining adequate accommodation. If they are not willing or able to adapt to requirements of traditional supported housing institutions they may live in sheltered and emergency accommodation. Adequate mental health services are rarely available in these faciliti...

Main goal of this review is to identify predictive factors for the outcome of Individual Placement and Support (IPS) with a focus on Supported Employment (SE) and of pre-vocational training (PVT) of individuals with mental illness. A systematic search of PsychInfo, PubMed, PsychIndex and PsyArticles was conducted. Studies were included if they comp...

OBJECTIVES: Main goal of this review is to identify predictive factors for the outcome of Individual Placement and Support (IPS) with a focus on Supported Employment (SE) and of pre-vocational training (PVT) of individuals with mental illness. METHOD: A systematic search of PsychInfo, PubMed, PsychIndex and PsyArticles was conducted. Studies were i...

Häufig sind Ärzte mit Patienten konfrontiert, die diagnostische oder therapeutische Vorschläge des Behandlers ablehnen. Insbesondere in der Psychiatrie kann es dabei zu ethisch und/oder rechtlich problematischen Situationen kommen, wenn ein psychisch kranker Patient eine eindeutig indizierte Maßnahme ablehnt und dadurch sich oder seine Umwelt gefäh...

This study aims to investigate clients' satisfaction with individual placement and support (IPS) at the University Hospital for Psychiatry Zurich (PUK). Furthermore, this study aims to investigate if clients feel the approach of IPS as a useful approach to fulfill their needs. One hundred twenty-five people were recruited from one of the three IPS...

The use of different aspects of coercion in mental healthcare currently underlies extensive ethical, legal and professional discussionsand aspects of clinical practice have been changing within the last decade. Based on available evidence and knowledge of legislation and politicaldiscussions, an overview is given on the following aspects in Switzer...

Background: Evaluations of the recovery orientation of mental health services have focused on outpatient and rehabilitative rather than acute inpatient facilities. Aim: This naturalistic observational study seeks to evaluate the subjective perspective and functional outcome of inpatients before and after structural alterations. The changes made...

The present study evaluated a new integrated treatment concept offering inpatient care, acute psychiatric day hospital and outpatient treatment by the same therapeutic team. 178 patients participated in this randomized controlled trial. Data on psychopathology, global and social functioning, patient satisfaction, continuity of care and administrati...

This pilot study aimed at investigating how mental health professionals on acute psychiatric wards recognize different levels of formal and informal coercions and treatment pressures as well as their attitude towards these interventions. An explorative cross-sectional survey among mental health professionals (N=39) was conducted using a questionnai...

Subject: This study aims at investigating the formal and content-related quality of medical certificates directing compulsory hospital admissions before the scheduled alteration of the Swiss civil legislation in January 2013. A comparison between physicians with different professional backgrounds concerning certificates and patients was conducted....

Fragestellung: Diese Studie hat zum Ziel, die vor Einführung des neuen Kindes- und Erwachsenenschutzrechts per Januar 2013 bestehende Praxis der Fürsorgerischen Freiheitsentziehung (FFE) anhand formaler und inhaltlicher Kriterien der Zuweisungsschreiben zu untersuchen. Hinweise auf Unterschiede zwischen Zuweisern mit verschiedenen professionellen H...

Providing care and support for individuals with severe mental illness in sheltered and supported housing facilities is frequently characterized by difficult courses, particularly if it concerns residents with "heavy user" profiles. These individuals oftentimes change their residence and are extensively hospitalized on acute psychiatric wards. To da...

Subject: Providing care and support for individuals with severe mental illness in sheltered and supported housing facilities is frequently characterized by difficult courses, particularly if it concerns residents with “heavy user” profiles. These individuals oftentimes change their residence and are extensively hospitalized on acute psychiatric war...

To evaluate professionals' attitudes to recovery and coercion, as well their satisfaction with working conditions before and after the implementation of a recovery-oriented ward concept on an admission ward. Longitudinal study design with two measurement times of the study sample, with a control group assessed at study end. Evaluating the implement...

Anliegen: Ermittlung soziodemografischer, klinischer und behandlungsbezogener Parameter sowie die Häufigkeit von Platzierungsaufträgen in betreute Wohnformen bei 18 – 65-jährigen Patienten mit langem Aufenthalt auf einer psychiatrischen Akutstation. Methode: Fünfjährige retrospektive Kohortenstudie (n = 3928). Ergebnisse: Charakteristika von Patien...

Objective: This paper describes socio-demographic, clinical, and treatment-related parameters of psychiatric patients who were hospitalized for at least two months on an acute psychiatric ward compared to patients with a shorter inpatient treatment episode. Furthermore, it is evaluated how frequent these long-staying patients are awaiting a room i...