title: Successful interventions on an organisational level to reduce violence and coercive interventions in in-patients with adjustment disorders and personality disorders.
abstract: BACKGROUND
  Self-directed and other violence as well as subsequent coercive interventions occur in a substantial proportion of patients with personality disorders during in-patient treatment. Different strategies may be required to reduce coercive interventions for patients of different diagnostic groups.
  
  
  METHODS
  We specialised one of our acute admission wards in the treatment of personality disorders and adjustment disorders (ICD-10 F4 and F6). Patients are not transferred to other acute wards in case of suicidal or violent behaviour. Violent behaviour and coercive interventions such as seclusion or restraint were recorded in the same way as in the rest of the hospital. We recorded the percentage of subjects affected by diagnostic group and average length of an intervention in the year before and after the change in organisational structure.
  
  
  RESULTS
  The total number of coercive interventions decreased by 85% both among patients with an F4 and those with an F6 primary diagnosis. Violent behaviours decreased by about 50%, the proportion of involuntary committed patients decreased by 70%.
  
  
  CONCLUSIONS
  The organisational change turned out to be highly effective without any additional cost of personnel or other resources.
authors.affiliation: Centre for Psychiatry Weissenau, Clinical Department, Germany. tilman.steinert@zfp-weissenau.de.
authors.forename: Tilman
authors.initials: T
authors.lastname: Steinert
authors.forename: Frank
authors.initials: F
authors.lastname: Eisele
authors.forename: Ulla
authors.initials: U
authors.lastname: Goeser
authors.forename: Stefan
authors.initials: S
authors.lastname: Tschoeke
authors.forename: Carmen
authors.initials: C
authors.lastname: Uhlmann
authors.forename: Peter
authors.initials: P
authors.lastname: Schmid