title: [Long-Term Tendencies in the Use of Seclusion and Restraint in Five Psychiatric Hospitals in Germany].
abstract: OBJECTIVE
  To evaluate multiple efforts of the last decade to reduce the use of coercive measures in psychiatric hospitals.
  
  
  METHODS
  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.
authors: Zentrum für Psychiatrie Südwürttemberg, Klinik Weissenau, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm.
authors: Tilman
authors: T
authors: Steinert
authors: Psychiatrische Klinik der Kliniken Landkreis Heidenheim gGmbH.
authors: Martin
authors: M
authors: Zinkler
authors: Zentrum für Psychiatrie Südwürttemberg, Klinik Bad Schussenried.
authors: Hans-Peter
authors: HP
authors: Elsässer-Gaißmaier
authors: Klinik an der Lindenhöhe Offenburg.
authors: Axel
authors: A
authors: Starrach
authors: Bezirkskrankenhaus Kaufbeuren.
authors: Sandra
authors: S
authors: Hoppstock
authors: Zentrum für Psychiatrie Südwürttemberg, Klinik Weissenau, Klinik für Psychiatrie und Psychotherapie I der Universität Ulm.
authors: Erich
authors: E
authors: Flammer
mesh_terms: D003068:Coercion; D003430:Cross-Sectional Studies; D019317:Evidence-Based Medicine / Q000331:legislation & jurisprudence; D005544:Forecasting; D005858:Germany; D006778:Hospitals, Psychiatric / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data* / Q000639:trends; D006801:Humans; D017063:Outcome Assessment, Health Care / Q000331:legislation & jurisprudence; D010356:Patient Isolation / Q000331:legislation & jurisprudence* / Q000523:psychology / Q000639:trends*; D012149:Restraint, Physical / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data; D014754:Violence / Q000331:legislation & jurisprudence* / Q000517:prevention & control* / Q000523:psychology / Q000639:trends*