No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Nach der Reform ist vor der Reform: Ergebnisse der Novellierungsprozesse der Psychisch-Kranken-Hilfe-Gesetze der Bundesländer
Abstract
Background
On the basis of mental health law, which differs between the federal states in Germany, courts can order the involuntary commitment of people with severe mental disorders in psychiatric hospitals, if they present a danger to themselves or to others. Due to decisions of the highest courts, these laws have been subject to revision since 2011. The aim of this paper is to analyze and compare the results of the revision processes in order to define the need for action for federal and state legislature.
Material and methods
Research of the current status of the revision processes in the federal states and a comparative analysis. The state laws were compared on the basis of selected particularly relevant areas with respect to human rights and treatment.
Results
In spite of the revisions the state laws are extremely heterogeneous and in many states do not fully comply with the requirements of the United Nations Convention on the Rights of Persons with Disabilities (UN-CRPD) or the highest courts’ decisions.
Conclusion
The state laws should be harmonized, particularly where they restrict basic and human rights, e. g. regarding prerequisites and objectives of involuntary commitment and coercive measures.
... Dabei können Zwangsmaßnahmen als Einschränkung der Bewegungsfreiheit in Form von gesetzlicher Unterbringung, Fixierung und Isolierung oder im Rahmen diagnostischer und therapeutischer Maßnahmen erfolgen [3]. Innerhalb der letzten Jahre erfuhr die Angemessenheit von Zwangsmaßnahmen eine zunehmend kritische Diskussion [4][5][6][7][8] und schließlich auch juristische Rezeption [7, [9][10][11]. ...
Zusammenfassung
Ziel der Studie Bundesweite Erfassung von Strukturdaten und der Anwendungshäufigkeit von Zwangsmaßnahmen im Maßregelvollzug in Deutschland.
Methodik Quantitative Erhebung von Strukturmerkmalen in Maßregelvollzugseinrichtungen und Häufigkeiten und Arten von Zwangsmaßnahmen mittels postalischer Fragebögen im Rahmen der „ZIPHER“-Studie.
Ergebnisse Zwangsmaßnahmen kommen in stationären Maßregelvollzugseinrichtungen bei etwa einem Viertel aller Patienten zur Anwendung, wobei Isolierungen (21,2 %) mehr als 6-mal so häufig wie Fixierungen (3,2 %) sind. Dies steht in Diskrepanz zur Allgemeinpsychiatrie, wo die Rate an Fixierungen höher ist.
Schlussfolgerung Die Ergebnisse der vorliegenden Studie zeigen Besonderheiten in der Anwendungshäufigkeit von Zwangsmaßnahmen im Maßregelvollzug auf Bundesebene. Dabei wurde offenbar, dass hinsichtlich der Verfügbarkeit grundlegender Struktur- und Prozessdaten des Maßregelvollzugs in Deutschland ein erhebliches Defizit besteht.
Abstract
Objective Nationwide assessment of structural data and the frequency of use of coercive measures in forensic psychiatric hospitals in Germany.
Methods Quantitative survey using a postal questionnaire on structural data and on the use of coercive measures in forensic psychiatric hospitals as part of the “ZIPHER” study.
Results About one fourth of all forensic patients are affected by coercive measures, with seclusion (21.2 %) being way more often than mechanical restraint (3.2 %). This ratio contrasts with general psychiatric hospitals, where restraints are more common than seclusions.
Conclusion The results of the study reveal nationwide peculiarities in the use of coercive measures in forensic psychiatric hospitals. At the same time, it demonstrated the lack of general structural and process data of forensic hospitals in Germany.
... However, emergency treatment is restricted to a single treatment in an acute life-threatening crisis. After a reform of the guardianship law in February 2013 and of the Mental Health Laws (PsychKHGs) of the 16 federal states between 2015 and 2018, compulsory treatment in patients with lack of insight into their illness is permitted again but only after judicial approval with strict procedural requirements (e.g., after a distinct court decision, which is based on the expertise of an independent psychiatrist; if there is a danger to the patient's or others' health or life, after considerable efforts to persuade the patient to have treatment have failed) (4). ...
Objective: Between June 2012 and February 2013, two decisions by the German Federal Constitutional Court restricted the so-far common practice to use involuntary medication in inpatients who were involuntarily hospitalized. Up to then, involuntary medication was justified by a judge’s decision on involuntary hospitalization. It could be applied according to clinical judgment even against the declared will of a patient. Since then, all domestic laws related to involuntary treatment had to be revised. For several months, involuntary medication was allowed only in an emergency. We were interested in the impact of the changed legal framework on the experiences of inpatients, their relatives, and clinical professionals during that time.
Methods: Thirty-two interviews were analyzed qualitatively using a grounded theory methodology framework.
Results: As a consequence of the restrictions to involuntary medication, special efforts by nursing and medical staff were required concerning de-escalation, ward management, and the promotion of treatment commitment in inpatients who refused medication. Family caregivers were also under strong pressure. They wanted to help and to protect their relatives, but some also welcomed the use of coercion if the patient refused treatment. Most of the interviewed patients had not even noticed that their rights to refuse medication had been strengthened. They complained primarily about the involuntary hospital stay and the associated limitations of their everyday lives. While patients and family members evaluated the refusal of medication from a biographical perspective, the mental health care professionals’ focus was on the patients’ symptoms, and they understood the situation from a professional perspective. It was obvious that, in any of the four perspectives, the problem of feeling restricted was crucial and that all groups strived to gain back their scope of action.
Conclusion: The temporary ban on involuntary medication questioned the hitherto common routines in inpatient treatment, in particular when patients refused to take medication. Each of the different groups did not feel good about the situation, for different reasons, however. As a consequence, it might be indispensable to increase awareness of the different perspectives and to focus the efforts on the establishment of nonviolent treatment structures and practices.
... 'More' means more satisfied than the reference country. 19 It is hoped that analysis of the qualitative responses from each country included in the survey will enable these patterns to be more clearly understood. The total score of the MHLAS provides a composite measure of attitudes in this area, and the analysis here indicates relative dissatisfaction amongst respondents in some roles and some countries. ...
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.
Zusammenfassung
Hintergrund Eine Evaluation der Praxis ärztlicher Zwangsbehandlungen nach den Entscheidungen des Bundesverfassungsgerichts zur Zwangsbehandlung 2011 steht bisher aus.
Methode An 6 Klinikstandorten in Baden-Württemberg wurden die dokumentierten Notfallbehandlungen (N=86) und richterlich genehmigte Zwangsbehandlungen (N=62) in den Jahren 2015 und 2016 retrospektiv analysiert.
Ergebnisse Patienten mit richterlich genehmigter Zwangsbehandlung hatten durchschnittlich 8 psychiatrische Voraufenthalte mit einer kumulativen Dauer von 645 Tagen und hatten zu 87% eine psychotische Störung. Bei 34% erfolgte innerhalb eines Jahres eine weitere Zwangsbehandlung. 92% der Patienten nahmen bei der Entlassung ein Antipsychotikum ein, 45% wurden in einer Tagesklinik oder einer Psychiatrischen Institutsambulanz weiterbehandelt.
Schlussfolgerung Ärztliche Zwangsbehandlung betrifft eine relativ kleine, überwiegend chronisch schwer erkrankte Patientengruppe und tritt bei dieser häufig wiederkehrend auf.
Zusammenfassung
Ziel der Studie Es soll ein empirischer Überblick über die Praxis von psychiatrischen Zwangseinweisungen gegeben werden.
Methodik Anhand der Krankenakten erfolgte eine retrospektive Auswertung von 346 Fällen mit einer Zwangseinweisung auf öffentlich-rechtlicher Grundlage im Jahre 2020 (21,0% aller vollstationären Aufnahmen in diesem Zeitraum).
Ergebnisse Der häufigste Grund für eine Zwangseinweisung war eine Suizidankündigung (45,4%). Diagnostisch standen Suchterkrankungen (30,1%), Belastungsstörungen (19,9%) und schizophrene Psychosen (18,8%) im Vordergrund. In nur 12,7% der Fälle führte die Zwangseinweisung zu einer anschließenden richterlichen Unterbringung, in 44,5% kam es zu einer Entlassung innerhalb von 24 Stunden.
Schlussfolgerung Zwangseinweisungen stellen häufig eine fürsorgliche Maßnahme dar, um auf suizidale Krisen zu reagieren. Es bleibt abzuwarten, ob die Etablierung von alternativen Hilfsmodellen wie psychosozialer Krisendienste die Anzahl von Zwangseinweisungen verringern kann.
Epidemiological registers on the burden of disease and adverse events (deaths, serious side effects, etc.) play an important role in the management, evaluation, and improvement of healthcare treatment for the population. This also applies to coercive measures in the psychiatric healthcare system. Such registers only became feasible on a broad basis due to the availability of electronic medical records and steadily increasing computing capacities; however, in most German states, registers have not been implemented. Data protection problems must be taken into account in the collation of person-related data but can be solved by appropriate pseudonymization procedures taking the prerequisites of data parsimony into account. Extensive data are now available from the Baden-Wuerttemberg register for coercive measures, which has been in existence since 2015 and which enabled, for instance, evaluating the consequences of the changes to the law following the 2018 ruling of the Federal Constitutional Court on mechanical restraint and the consequences of the coronavirus pandemic. In the meantime, there are also state-wide data collections in some other German states; however, unlike in Baden-Wuerttemberg, these registers do not include measures under guardianship law. A nationwide register for coercive measures, compulsory treatment and involuntary detention has justifiably repeatedly been demanded for a long time. A major obstacle is the historically developed separation between the responsibility of the German states for the detention regulated by public law and the Federal State for the scope of application of the guardianship law.
Zusammenfassung
Ziel der Studie Die vorliegende Studie untersuchte mit einer angestrebten Vollerhebung den Dokumentationsstatus bezüglich Unterbringungen und Zwangsmaßnahmen in psychiatrischen Kliniken in Deutschland.
Methodik Im Rahmen der ZIPHER-Studie wurde eine Fragebogenerhebung hinsichtlich der Dokumentation, Anwendung und Bemühungen zur Reduktion von Zwang durchgeführt (N = 147, Rücklaufquote = 34,4 %).
Ergebnisse Die teilnehmenden Kliniken berichteten überwiegend von einer umfassenden Dokumentation von Zwangsmaßnahmen, jedoch zeigten sich sowohl diesbezüglich als auch für den Einsatz von Leitlinien erhebliche regionale Unterschiede. Die Unterbringungsquote lag bei M = 13,4 % (± 10,9). Von diesen waren 33,9 % (± 22,2) von Fixierung betroffen, 8,9 % (± 17,2) von Isolierung und 11,8 % (± 18,0) von Zwangsmedikation.
Schlussfolgerung Die regionalen Unterschiede rufen zu einer Vereinheitlichung der rechtlichen Grundlagen und praktischen Anwendung sowie einer flächendeckenden Zusammenführung der entsprechenden Daten auf.
On 23 July 2018 the German Constitutional Court decided that mechanical restraint in psychiatric patients with 5 or 7‑point mechanical restraint lasting longer than 30 min requires a judicial authorization. On the same day, the German Association for Psychiatry and Psychotherapy (DGPPN) published guidelines on the prevention of coercion and violence. Together, this can be considered as the strongest intervention to reduce coercion on a national level worldwide. The registry for coercive measures in the Federal State of Baden-Wuerttemberg, available since 2015 and comprising all 32 hospitals licensed to admit involuntary patients, has made it possible to evaluate the effect of the legal change. We analyzed the mean percentage of patients subjected to coercive measures and the mean cumulative duration of these interventions in ICD-10 diagnostic groups in psychiatric hospitals from 2015 to 2017 compared to 2019 among a total of 438,003 admissions. 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). Effects were strongest in patients with organic (F0) and schizophrenic disorders (F2). The percentage of patients subjected to mechanical restraint decreased from 4.8% to 3.6% in 2019, and the percentage of mechanical restraints less than 30 min increased from 1.8% to 10.5%. Vice versa, 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 10.9 h (median). The intervention was probably responsible for a reduction of the percentage of cases subjected to coercive measures by about 13% and a reduction of the duration of these measures per affected case by about 14%.
Large scale prospective cohorts have now been established across several countries, and continents, and among the aims include an assessment of the developmental trajectory of mental disorders. This level of international cooperation helps transfer research findings to new social contexts as well as enabling an assessment of which findings can be replicated, and which interventions are most effective, in different social and cultural settings. However, data sharing across different regional and national health care systems requires a careful consideration of different standards in ethical research, data protection and patient care, including respect for patients’ rights, in cooperating jurisdictions. In our review, we discuss ethical, legal and practical challenges associated with such cooperation with a focus on research participants, specifically patient recruitment, by considering the instance of China and Germany. Our broader aim is to promote international cooperation by identifying key challenges that arise in international cooperation, and to facilitate an exchange in relation to legal and practical approaches.
Neben der strafrechtlichen und zivil- bzw. betreuungsrechtlichen Unterbringung gibt es für akute Notfälle auch die mögliche Unterbringung nach öffentlichem Recht gemäß der jeweiligen Gesetzgebung der Bundesländer. Dargestellt werden die Voraussetzungen für eine mögliche derartige Unterbringung und die inhaltlichen Anforderungen beim diagnostischen Vorgehen und bei der Beurteilung im Rahmen der Gutachten und Stellungnahmen.
Background
Currently, it is a topic of debate whether psychiatric hospitals can and should be managed with a full open door policy. The revised legislation of public law for involuntary commitment explicitly allows or even encourages such practice in several German federal states. In parts of Austria, open doors are required for legal reasons. A systematic literature search was conducted for articles providing empirical data related to this issue.
Method
Literature search in PubMed augmented by a manual search in references of retrieved papers and reviews with similar objectives.
Results
A total of 26 articles reporting empirical data could be identified. Most of these articles came from Germany or Switzerland. The majority were published within the past 5 years. The definition of “open doors” ranged from an only vaguely defined open door policy up to explicit set time periods with open doors. Some studies reported a decrease in coercive interventions. No study reported any associated adverse events resulting from open doors in psychiatric wards.
Discussion
Generally, all studies had methodological weaknesses. Prospective randomized controlled studies or quasi-experimental studies are missing in the context of European healthcare systems. The risk of bias was considerable in most studies. A final conclusion regarding the possible extent of psychiatry with open doors and the associated risks is currently not possible. There is an urgent need for future high-quality prospective studies.
Zusammenfassung
Obwohl sich ärztliches Handeln im Wesentlichen und v. a. durch das Wohl des Patienten und seine Zustimmung legitimiert, können auch Interessen Dritter rechtfertigend wirken. Dieser Beitrag widmet sich der Frage, unter welchen Umständen dies der Fall bzw. nicht der Fall ist. Dabei zeigt sich, dass fremdnütziges medizinisches Handeln insbesondere dann problematisch ist, wenn die Interessen Dritter alleiniger Rechtfertigungsgrund sind, wenn also ärztliches Handeln nicht dem Willen des Patienten entspricht und nicht auch seinem eigenen Wohl dient. Die Problematik wird an einer Reihe von Beispielen beleuchtet, insbesondere am Schwangerschaftsabbruch und an der Unterbringung von Menschen mit psychischen Erkrankungen in psychiatrischen und forensischen Kliniken gegen ihren Willen. Die fremdnützige Unterbringung von Menschen mit psychischen Erkrankungen in psychiatrischen Krankenhäusern scheint immer dann problematisch, wenn nicht sogar illegitim, falls dort eine Behandlung nicht durchgeführt werden kann. Dabei ist es unerheblich, ob der freie, vorausverfügte oder mutmaßliche Wille des Betroffenen die Behandlung unmöglich macht, oder aber, ob es Behandlungsmöglichkeiten gar nicht gibt. Es scheint darüber hinaus fragwürdig, ob die Umsetzung von ausschließlich fremdnützigen Sicherungsmaßnahmen, die keinem Behandlungszweck dienen, durch Ärzte berufsethisch und -rechtlich zu rechtfertigen ist. Allerdings hat sich die medizinethische Literatur bisher kaum mit den Rechtfertigungsgründen fremdnütziger Zwangsmaßnahmen befasst, sodass hier erheblicher Forschungsbedarf zu bestehen scheint.
Die ,,Studie zur Gesundheit Erwachsener in Deutschland“ (DEGS1) und ihr Zusatzmodul ,,Psychische Gesundheit“ (DEGS1-MH) erlauben erstmals seit dem 15 Jahre zurückliegenden Bundesgesundheitssurvey (BGS98) aktuelle Abschätzungen zu Morbidität, Einschränkungsprofilen und Inanspruchnahmeverhalten der deutschen Erwachsenen. Es werden die wichtigsten Ergebnisse zu Prävalenzen psychischer Störungen, zu damit assoziierten Beeinträchtigungen sowie zu Kontaktraten mit Gesundheitsdiensten berichtet.Der Studie liegt eine bevölkerungsrepräsentative Erwachsenenstichprobe (18–79 Jahre, n = 5317) zugrunde, die überwiegend persönlich mit ausführlichen klinischen Interviews (Composite International Diagnostic Interview; CIDI) untersucht wurde.Die 12-Monats-Prävalenz psychischer Störungen beträgt insgesamt 27,7 %, wobei große Unterschiede in verschiedenen Gruppen (z. B. Geschlecht, Alter, sozialer Status) zu verzeichnen sind. Psychische Störungen stellten sich als besonders beeinträchtigend heraus (erhöhte Zahl an Einschränkungstagen). Weniger als die Hälfte der Betroffenen berichtet, aktuell wegen psychischer Probleme in Behandlung zu stehen (10–40 % in Abhängigkeit von der Anzahl der Diagnosen).Psychische Störungen sind häufig. Die im Vergleich zu Personen ohne aktuelle psychische Diagnose deutlich erhöhte Rate an Beeinträchtigungstagen signalisiert neben dem individuellen Leiden der Betroffenen eine große gesellschaftliche Krankheitslast – auch verglichen mit vielen körperlichen Erkrankungen. Trotz des in Deutschland vergleichsweise gut ausgebauten Versorgungssystems für psychische Störungen ist Optimierungsbedarf hinsichtlich der Behandlungsrate zu vermuten.
This paper provides up-to-date data on service use for mental health problems and disorders among adults aged 18-79 years in Germany derived from the Mental Health Module of the German Health Interview and Examination Survey for Adults (DEGS1-MH; N=4483). Data are based exclusively on self-report. Respondents were examined by clinically trained interviewers with a modified version of the Composite International Diagnostic Interview DIA-X/M-CIDI to assess diagnoses according to the criteria of DSM-IV-TR. Service use, i.e. contact to mental health care services, due to mental health problems was assessed for the past 12 months and lifetime, by type of sector and type of institution. Among respondents with a 12-month diagnosis of a mental disorder, 23.5% of the women and 11.6% of the men reported any service use in the past 12 months. Service use depends on type of diagnosis, comorbidity and socio-demographic characteristics. Lowest 12-month utilization rates were found for substance use disorders (15.6%; lifetime use 37.3%), highest for psychotic disorders (40.5%; lifetime 72.1%). Further, a considerable time lap was found between disorder onset and subsequent service use among the majority of cases with anxiety and mood disorders. This paper provides self-reported epidemiological data on mental health service use in Germany, complementing administrative statistics and the predecessor mental health module of the German Health Interview and Examination Survey (GHS-MHS) from 1998. Despite considerable changes in the mental health field in Germany and the existence of a comprehensive mental health care system without major financial barriers, we find no indications of substantially higher utilization rates for mental disorders as compared to other comparable European countries. Further, no indications of major overall changes in utilization rates are apparent. To pinpoint areas with unmet needs, more detailed analyses of the data are needed taking into account type, frequency, and adequacy of service use and treatment of mental disorders. Appropriately matched comparisons with the GHS-MHS are needed to identify changes in patterns of utilization and interventions by type of disorder. Copyright © 2014 John Wiley & Sons, Ltd.
The German health interview and examination survey for adults (DEGS1) with the mental health module (DEGS1-MH) is the successor to the last survey of mental disorders in the general German population 15 years ago (GHS-MHS). This paper reports the basic findings on the 12-month prevalence of mental disorders, associated disabilities and self-reported healthcare utilization.
A representative national cohort (age range 18-79 years, n = 5,317) was selected and individuals were personally examined (87.5 % face to face and 12.5 % via telephone) by a comprehensive clinical interview using the composite international diagnostic interview (CIDI) questionnaire.
The overall 12-month prevalence of mental disorders was 27.7 % with substantial differences between subgroups (e.g. sex, age, socioeconomic status). Mental disorders were found to be particularly impairing (elevated number of disability days). Less than 50 % of those affected reported to be in contact with health services due to mental health problems within the last 12 months (range 10-40 % depending on the number of diagnoses).
Mental disorders were found to be commonplace with a prevalence level comparable to that found in the 1998 predecessor study but several further adjustments will have to be made for a sound methodological comparison between the studies. Apart from individual distress, elevated self-reported disability indicated a high societal disease burden of mental disorders (also in comparison with many somatic diseases). Despite a relatively comprehensive and well developed mental healthcare system in Germany there are still optimisation needs for treatment rates.
BACKGROUND: Psychiatric advance directives are intended to enable self-determined treatment for patients who lose decisional capacity, and thus reduce the need for coercive interventions such as police transport, involuntary commitment, seclusion and restraints, and involuntary medications during mental health crises; whether PADs can help prevent the use of these interventions in practice is unknown. AIMS: This study examined whether completion of a Facilitated Psychiatric Advance Directive (F-PAD) was associated with reduced frequency of coercive crisis interventions. METHOD: The study prospectively compared a sample of PAD completers (n=147) to non-completers (n=92) on the frequency of any coercive interventions, with follow-up assessments at 6, 12, and 24 months. Repeated-measures multiple regression analysis was used to estimate the effect of PADs. Models controlled for relevant covariates including a propensity score for initial selection to PADs, baseline history of coercive interventions, concurrent global functioning and crisis episodes with decisional incapacity. RESULTS: F-PAD completion was associated with lower odds of coercive interventions (adjusted OR=0.50; 95% CI=0.26-0.96; p < 0.05). CONCLUSIONS: PADs may be an effective tool for reducing coercive interventions around incapacitating mental health crises. Less coercion should lead to greater autonomy and self-determination for people with severe mental illness.
Zusammenfassung
Die UN-Behindertenrechtskonvention (UN-BRK) hat die Rechtsprechung und Gesetzgebung zur Psychiatrie in Deutschland beeinflusst. Sie hat bei richtungweisenden Entscheidungen des Bundesverfassungsgerichts und des Bundesgerichtshofs eine Rolle gespielt, durch die Novellierungen des Betreuungsrechts und verschiedener Landesgesetze (PsychischKranken-, Unterbringungs- und Maßregelvollzugsgesetze) veranlasst wurden.
Außerdem hat sie eine intensive Diskussion innerhalb der Psychiatrie angestoßen, die inzwischen zu einem kritischeren und zurückhaltenderen Umgang mit Zwangsbehandlungen geführt hat.
Die Auslegung der UN-BRK ist allerdings umstritten. Das von der UNO eingesetzte "Committee on the Rights of Persons with Disabilities" (CRPD) hat 2014 in seinem "General Comment on Article 12 of the UN Convention" eine Interpretation der UN-BRK veröffentlicht, die in problematischer Weise von früheren internationalen Vereinbarungen über Menschenrechte und früheren WHO-Empfehlungen abweicht. Darin fordert das CRPD u.a. die völlige Abschaffung von ersetzenden Entscheidungen durch rechtliche Betreuer sowie die vollständige Abschaffung von Unterbringungen und Zwangsmaßnahmen. Von Seiten der Bundesregierung wird die Auslegung des CRPD nicht anerkannt. Auch das Bundesverfassungsgericht hat in einer Entscheidung zu Zwangsbehandlungen zum einen festgestellt, dass die Stellungnahmen des CRPD für internationale und nationale Gerichte nicht völkerrechtlich verbindlich sind. Zum anderen hat es die Position des CRPD inhaltlich kritisiert und insbesondere dargelegt, dass aus der UN-BRK keineswegs folgt, dass es keinerlei ersetzende Entscheidungen und keinerlei Zwangsbehandlungen geben dürfe. Vielmehr sieht das Bundesverfassungsgericht eine Schutzpflicht des Staates gerade für Menschen, die aufgrund von Krankheit oder Behinderung keinen freien Willen bilden können und sich in hilfloser Lage befinden. Diese Menschen sollten nicht ihrem Schicksal überlassen werden.
Das Bundesverfassungsgericht hat die UN-BRK interpretiert, indem es zwischen den verschiedenen Grundrechten abgewogen und zwischen dem freien und dem natürlichen Willen differenziert hat, während das CRPD ein naiv verstandenes Recht auf Selbstbestimmung absolut gesetzt hat.
Kapitel 2 gibt einen Überblick über die verfügbare Datenlage zu zwangsweisen Unterbringungen sowie Zwangsmaßnahmen und -behandlungen und vergleicht diese auf nationaler und anschließend auf EU-Ebene. Es wird herausgestellt, dass die Zahlen der Zwangsunterbringungen sowohl auf Grundlage des Betreuungsrechts als auch auf öffentlich-rechtlicher Grundlage kontinuierlich angestiegen sind. Ein allmählicher Rückgang ist erst in den letzten Jahren zu erkennen. Dabei wird deutlich, dass die Zahlen der zwangsweisen Unterbringungen innerhalb der EU-Mitgliedstaaten, aber auch innerhalb Deutschlands zwischen den einzelnen Bundesländern, Kommunen, Gerichtsbezirken und Kliniken stark divergieren. Verlässliche Statistiken zur Zahl der Zwangsmaßnahmen und -behandlungen bestehen hingegen nicht, sodass Entwicklungen und Vergleiche überwiegend nur aufgrund von Schätzungen dargestellt werden können. Schließlich wird in einem Ausblick auf die Möglichkeit eines bundesweiten Melderegisters hingewiesen.
Study objective:
A simple instrument to record case-related coercive measures was tested as part of a pilot project of the German Association for Psychiatry, Psychotherapy and Psychosomatics (DGPPN).
Methods:
To assess coercive measures data were collected for 3 months in 8 German hospitals for psychiatry and psychotherapy. The type of measures used, the main diagnosis and the legal basis for the coercive measures were documented.
Results:
In the sample studied, coercive measures were applied in 8% of cases. Coercive measures were most commonly used in patients with a schizophrenic disorder. The principle of justifiable necessity according to § 34 of the German Penal Code was used particularly often as the legal basis for justifying the coercive measures.
Conclusion:
Suitable measurement instruments and reliable data that enable the learning of best practices represent the basis for a reduction of coercive measures.
Objective:
Involuntary psychiatric admissions under the Mental Health Act increased significantly nationwide. Little is known, however, about the influencing factors of this phenomenon.
Methods:
The aim of this regional cross-sectional study in North Rhine-Westphalia was to compare voluntary and involuntary psychiatric admissions (under the PsychKG NRW) regarding personal, institutional, social-psychiatric and demographic characteristics. A retrospective analysis of hospital admission registers over a period of 6 years with over 200 000 cases was conducted.
Results:
Elderly patients with dementia were most frequently involuntarily admitted. The existence of a locked ward in hospitals did not per se increase involuntary admissions, whereas the scope and quality of local social-psychiatric services had a major impact.
Conclusion:
Social-psychiatric services and home-treatment must be strengthened to achieve lower involuntary admission rates and to further improve the quality of mental health care all over Germany.
Anliegen: Die Unterbringungsgesetze in den 16 deutschen Bundessländern sollen verglichen werden. Methode: Die Geschichte der Entstehung der Gesetze wird untersucht, die Gesetzestexte werden verglichen. Ergebnisse: Zwischen 1950 und 1956 war beabsichtigt, ein bundeseinheitliches Gesetz zu schaffen. Dies scheiterte an verschiedenen Interessengruppen. Die jetzt vorliegenden Gesetze weisen erhebliche Unterschiede im Hinblick auf vorgesehene Fristen, Verfahrenswege, Voraussetzungen und Beschreibungen von Rechten und Pflichten der Betroffenen auf. Diskussion: Die uneinheitliche Gesetzgebung ist mitverantwortlich für die sehr unterschiedlichen Unterbringungsraten und erschwert eine Evaluation der Behandlungspraxis.
Despite the accumulation of evidence demonstrating patients' accounts of trauma associated with seclusion, the use of evidence-based post-seclusion debriefing is not apparent in the published work. This study aimed to identify the impacts seclusion has on an individual using the Impact of Events - Revised (IES-R), a standardized and widely used measure of trauma symptoms, and measure the effectiveness of a post-seclusion counselling intervention in mitigating the experience of seclusion-related trauma and reducing time spent in seclusion. The study design involved a comparison of the seclusion-related trauma and time in seclusion that was experienced by consenting patients managed on the two inpatient wards of Alfred Psychiatry. To investigate the efficacy of post-seclusion counselling to reduce event-related trauma as well as the use of seclusion, a brief single-session intervention was piloted comparing outcomes for patients treated on a ward implementing semistructured post-seclusion counselling and patients treated on a ward continuing with post-seclusion support as usual. A total of 31 patients consented to participate, with approximately 47% reporting trauma symptoms consistent with 'probable post-traumatic stress disorder' (IES-R total score, >33), although there was no difference in trauma experience between groups. Significantly fewer hours were spent in seclusion for patients treated on the ward piloting the post-seclusion counselling intervention. Findings, therefore, highlight not only the potential for significant trauma stemming from a seclusion event, but also the capacity for the implementation of such interventions as post-seclusion counselling to raise awareness of the need to minimize time spent in seclusion for patients.
To compare long-term trends in legal guardianship policy and involuntary psychiatric admissions in urban and rural areas for people suffering from mental illness.
New and current legal guardianships as well as involuntary admissions according to Guardianship Law and also to Commitment Law were examined from 1998 to 2010.
All investigated variables (new and current legal guardianships as well as involuntary admissions) increased significantly along assessed period of time. Current guardianship rates are lower in urban area. On the other hand, rates of involuntary admissions according to Guardianship Law are in urban area 3fold higher and those according to Commitment Law doubled. New and current guardianships' ratio as well as ratio between involuntary admissions according Commitment Law and Guardianship Law remained quite stable.
The large differences in legal guardianship policy and involuntary treatment between urban and rural regions cannot be explained on the basis of available data. The role of community-based care networks in the process of reducing involuntary admissions should be further examined.
This article describes the use of rapid response teams to reduce the use of mechanical restraints (i.e., restricting a person's movement through the use of a mechanical device such as a backboard, net, or papoose) in an acute psychiatric care setting. Rapid response teams have proven highly effective for emergent medical patients, but have not typically been used in behavioral health care settings. Utilizing a rapid cycle process improvement approach, a response team was convened following each episode of mechanical restraint in an inpatient psychiatric treatment facility. Initial results, during a 6-week rapid cycle change process, showed that mechanical restraints were reduced by 36.4% when compared with a 6-week baseline and when compared with a 1-year baseline. Changes in hospital census during the implementation process did not appear to account for the reduction in restraints. Rapid response teams and rapid cycle process improvement are discussed as useful change vehicles for behavioral health care organizations.
Zusammenstellung der Geschäftsübersichten der Amtsgerichte für die Jahre
- Justiz Bundesamt Für
- Bundesamt für Justiz
Zwangseinweisungen in die Psychiatrie
- C Brink
Die stationäre Unterbringung nach dem Psychisch-Kranken-Gesetz (PsychKG NRW) - was sind die stärksten Prädiktoren?
- G Juckel
- I Haußleitner
Psychosomatik und Nervenheilkunde (DGPPN) - Taskforce Patientenautonomie (2016) Eckpunkte für die Regelung der öffentlich-rechtlichen Unterbringung in psychiatrischen Krankenhäusern - mit Erläuterungen
- Deutsche Gesellschaft Für Psychiatrie Und Psychotherapie
Eckpunkte für die Regelung der öffentlich-rechtlichen Unterbringung in psychiatrischen Krankenhäusern - mit Erläuterungen