Effects of structural features of psychiatric hospital settings on coercive measures

Abstract Background and Objectives Involuntary hospital admissions and coercive measures are a long-lasting burden in psychiatry. Many efforts have been undertaken to diminish these wearing circumstances. With the Bochum “track system,” which is structured in mental health teams across inpatient and outpatient clinics without any closed admission wards, we would like to present a new way of facing coercion. To examine the effects of establishing the so-called Bochum “‘track system”’ regarding the presumed reduction of coercive measures within a naturalistic, quantitative pre- and post- comparison. Methods Routine data on coercive measures (involuntary admissions, mechanical restraints, compulsory medications, one-to-one care) from two years of treatment (2011, 2017) are compared (N = 257 involuntary admissions) before and after the introduction of the track system. Results By changing the general conditions of the hospital, it was possible to reduce the number of coercive measures in the affected cases. The proportion of cases affected by coercion also tended to decrease, with women in particular appearing to benefit from introduction of the track system. Conclusion Structural changes in psychiatric hospitals can have a significant impact on one of the important quality parameters of psychiatric treatment, namely coercive measures.