ABSTRACT
OBJECTIVE: The study analyses the number, characteristics and reasons for a length of stay of patients in German psychiatric clinics in excess of 6 months. METHODS: The study was implemented in the form of a nationwide online survey, which was addressed to chief physicians of psychiatric clinics. RESULTS: In the sample, 174 patients in 80 psychiatric clinics were identified who could not be discharged because no suitable follow-up services were available in the region. The majority of patients are male, often have an F2 diagnosis and exhibit aggressive behaviour during their hospital stay. CONCLUSION: To avoid inappropriate health care and prevent prolonged stays for a subgroup of mentally ill people, individual complex services should be implemented in community psychiatry.
ABSTRACT
BACKGROUND: Epidemiological studies have demonstrated considerable differences in the use of coercive measures among psychiatric hospitals; however, the underlying reasons for these differences are largely unclear. We investigated to what extent these differences could be explained by institutional factors. METHODS: Four psychiatric hospitals with identical responsibilities within the mental health care system, but with different inpatient care organizations, participated in this prospective observational study. We included all patients admitted over a period of 24 months who were affected by mechanical restraint, seclusion, or compulsory medication. In addition to the patterns of coercive measures, we investigated the effect of each hospital on the frequency of compulsory medication and the cumulative duration of mechanical restraint and seclusion, using multivariate binary logistic regression. To compare the two outcomes between hospitals, odds ratios (OR) with corresponding 95% confidence intervals (CI) were calculated. RESULTS: Altogether, coercive measures were applied in 1542 cases, corresponding to an overall prevalence of 8%. The frequency and patterns of the modalities of coercive measures were different between hospitals, and the differences could be at least partially related to institutional characteristics. For the two hospitals that had no permanently locked wards, certain findings were particularly noticeable. In one of these hospitals, the probability of receiving compulsory medication was significantly higher compared with the other institutions (OR 1.9, CI 1.1-3.0 for patients < 65 years; OR 8.0, CI 3.1-20.7 for patients ≥65 years); in the other hospital, in patients younger than 65 years, the cumulative duration of restraint and seclusion was significantly longer compared with the other institutions (OR 2.6, CI 1.7-3.9). CONCLUSIONS: The findings are compatible with the hypothesis that more open settings are associated with a more extensive use of coercion. However, due to numerous influencing factors, these results should be interpreted with caution. In view of the relevance of this issue, further research is needed for a deeper understanding of the reasons underlying the differences among hospitals.
Subject(s)
Hospitals, Psychiatric , Mental Disorders , Coercion , Humans , Mental Disorders/epidemiology , Mental Disorders/therapy , Patient Isolation , Restraint, PhysicalABSTRACT
This study provides for the first time a comprehensive overview of the state-of-the-practice of clinical ethics consultation in German psychiatric hospitals. Structures for ethics counselling were available in only 57â% of the hospitals. In about one third of the participating hospitals, structures of ethics counselling had not yet been considered or were actively dismissed. The remaining hospitals reported to be in the process of establishing ethical structures. With regard to team characteristics and concrete practical implementation, qualitative differences were found between the hospitals. In summary, ethical structures are already established in the more than half of the German psychiatric hospitals, but still there is a clear need both in terms of dissemination and the quality of practical implementation.
Subject(s)
Ethics Consultation , Hospitals, Psychiatric , Germany , HumansABSTRACT
BACKGROUND: Psychotherapy is an essential part of treating people with mental illness. However, the implementation of psychotherapeutic interventions in the field of inpatient psychiatric treatment remains well behind demand. At the same time, the use of psychotherapeutic interventions by other professional groups - such as social workers and nursing - is not a common practice in Germany. OBJECTIVE: What can we learn from the international research with regard to nursing for Germany in view of the insufficient supply of psychotherapeutic care. METHOD: Based on a literature analysis, the German situation of care is related to international developments and a German training curriculum is presented. RESULT: A look at the international literature shows that in other countries especially trained nurses perform psychotherapeutic Interventions. In addition, there are effective training curricula whose transferability to Germany appears to be possible after appropriate adjustments.An 18 months lasting training program for nurses is presented. In addition to disorder-specific competences, this curriculum also provides psychotherapeutic interventions with a general approach. CONCLUSION: Collaborative care in the collaboration of different health professionals has been repeatedly and stably proven to be effective and helpful in treating people with various mental disorders. In order to better meet the growing need for psychotherapeutic interventions in the population in the sense of a stepped care model, trained nurses need to be more involved in the provision of psychotherapeutic services.
