“Every fixation is one too many”

Coercion for the good of the patient? In a public hearing, the German Ethics Council critically examined corresponding measures in psychiatry and sought alternative methods.

Coercive measures in psychiatry raise considerable questions and require massive justification, Ethics Council Chairman Peter Dabrock said Thursday in Berlin at the public hearing. Some of those affected are later grateful, others struggle with the experience for the rest of their lives, Dabrock continued. Against this background, the Ethics Council wanted to develop a statement and a recommendation for action.

According to experts, there are more than 800 cases of coercion in Germany every year.000 inpatients in psychiatry. This figure has risen significantly in the past ten years. Of the approximately 420 psychiatric hospitals in Germany 400 would have a closed department, about 20 renounced such. According to experts, the range of cases of applied coercive measures varies greatly, from as little as 1 percent in some cases to around 10 percent. These include involuntary treatment of mental illness, medication immobilization or fixation.

As little coercion as possible

The director of the clinic for psychiatry and psychotherapy at the Berlin Charite, Andreas Heinz, welcomed the fact that the concept of an open psychiatry is becoming increasingly important. Locked doors often first lead to patients becoming aggressive and then coercion is used. Large wards also made care more difficult. In principle, as little coercion as possible should take place. Heinz also advocated for more mobile teams to visit sufferers at home. More staff is needed for this, as well as for good inpatient care, he said.

Martin Zinkler, Heidenheim's chief psychiatrist, reported that coercive measures are often a problem for nurses and doctors as well. Many were ashamed of it afterwards. This makes aftercare more difficult and worsens the learning effect for both sides. "Every fixation is one too many," said Zinkler. And forced drug treatment could make treatment more difficult, according to studies. There would have to be a stronger focus on the patient's social circumstances.

Judicial approvals

At the end of January, the federal cabinet had passed a bill to amend compulsory medical measures in response to a Federal Constitutional Court ruling. In the future, compulsory treatment and custodial care will each be subject to separate judicial approval. The prerequisite for a compulsory medical measure should be a full inpatient stay, so that medical follow-up care is also guaranteed.

Even after the new regulation, compulsory medical measures should only be the last resort "to be considered in situations of imminent significant danger to the self of the person under care," according to the draft law. For this reason, the government also wants to improve the right of self-determination of those being cared for by giving greater weight to living wills.

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