Socio-economic impact on involuntary admissions and coercive measures in psychiatric hospitals in Germany [2020]

• Admission rates increased significantly over the decade assessed, associated with an increase of admissions initiated in emergency situations.

• Admission rates, but not amount of coercive measures, differed significantly between socio-economic clusters.

• Comparing psychiatric specializations, geriatric psychiatry had the highest amount of involuntary admissions.

• Most coercive measures lasted at least one hour.

The present study aimed to characterize involuntary psychiatric admissions and coercive measures within psychiatric hospitals regarding their temporal development and processual aspects. Moreover, the influence of socio-economic factors on involuntary admissions and coercive measures was investigated.

Different data sets from the federal state of North-Rhine Westphalia (NRW) were used in this study. In addition to a survey in which n = 33 hospitals responded (40.7%), official data from the Federal Health Ministry were analysed over a decade regarding involuntary admissions and coercive measures. These data were available for all n = 54 districts, respectively, all n = 81 psychiatric hospitals in NRW. Datasets were mainly analysed comparing different socio-economic clusters.

The hospital admission rate increased significantly over time (from 1.12 to 1.34 per 1000 inhabitants) within ten years. However, whereas the admission rates differed significantly between socio-economic clusters, the amount of coercive measures used in the hospitals did not. Compared to general psychiatry and addiction medicine, geriatric psychiatry had the highest amount of involuntary admissions (12.2% under public law, 14.1% under civil law). Furthermore, most coercive measures lasted at least an hour.

It seems that, despite intense discussions and enhanced efforts to reduce coercion, there are still some neglected aspects, such as the need for coercive measures and their duration, particularly in the geriatric psychiatric setting. In addition, the results show that further approaches to prevent involuntary admissions are needed to address other stakeholders beyond the hospitals and further aspects of the socio-economic environment.

S.A. Efkemann, B.Ueberberg, I.S.Haußleiter, K.Hoffmann, G.Juckel
International Journal of Law and Psychiatry, Volume 71, July–August 2020