[Long-Term Tendencies in the Use of Seclusion and Restraint in Five Psychiatric Hospitals in Germany]. / Langzeittendenzen in der Anwendung von Fixierungen und Isolierungen in fünf psychiatrischen Kliniken.

OBJECTIVE: To evaluate multiple efforts of the last decade to reduce the use of coercive measures in psychiatric hospitals. METHOD: A working group for the prevention of violence and coercion in psychiatric hospitals has compared several outcome indicators since the year 2000 and repeatedly has provided evidence-based recommendations for clinical practice. We present data from those 5 hospitals with complete data sets recorded by an identical method over 9 years. RESULTS: The percentage of admissions exposed to any kind of coercive measure decreased from 8.2 % in 2004 to 6.2 % in 2012. The standard deviation of outcomes between hospitals decreased by 20 %. Changes in the duration of measures were mostly insignificant. CONCLUSIONS: Measures to reduce the use of coercion are effective in clinical practice, but to less extent than in clinical studies. A ban on all forced and non-consensual medical interventions, as being stipulated by the UN Special Rapporteur on Torture, has so far not materialized in the participating psychiatric institutions.