title: Association Between Restriction of Involuntary Medication and Frequency of Coercive Measures and Violent Incidents.
abstract: In the German federal state of Baden-Wuerttemberg, involuntary medication of psychiatric inpatients was illegal during eight months from July 2012 until February 2013. The authors examined whether the number and duration of mechanical coercive measures (seclusion and restraint) and the number and severity of violent incidents changed in this period.
  
  
  
  A cross-sectional analysis was conducted of admission-related routine data collected in seven psychiatric hospitals in three time periods (period 1, July 2011-February 2012; period 2, July 2012-February 2013; and period 3, July 2013-February 2014). All patients with psychotic disorders and at least one admission during at least one of the three time periods were included (N=2,071), for a total of 3,482 admissions.
  
  
  
  The mean number of mechanical coercive measures and violent incidents per admission increased significantly during period 2, when involuntary medication was not possible, and decreased significantly during period 3. They also differed significantly between periods 1 and 3. The percentage of admissions involving seclusion increased during period 2 significantly and was significantly different during period 1 compared with period 3. The severity of illness and the length of hospitalization did not change over the three periods.
  
  
  
  Restriction of involuntary medication was associated with a significant increase in use of mechanical coercive measures and violent incidents.
authors.affiliation: The authors are with the Department of Psychiatry and Psychotherapy I, Ulm University, and the Centers for Psychiatry Suedwuerttemberg, Ravensburg, Baden-Wuerttemberg, Germany (e-mail: erich.flammer@zfp-zentrum.de ).
authors.forename: Erich
authors.initials: E
authors.lastname: Flammer
authors.affiliation: The authors are with the Department of Psychiatry and Psychotherapy I, Ulm University, and the Centers for Psychiatry Suedwuerttemberg, Ravensburg, Baden-Wuerttemberg, Germany (e-mail: erich.flammer@zfp-zentrum.de ).
authors.forename: Tilman
authors.initials: T
authors.lastname: Steinert
mesh_terms: D000328:Adult; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D003430:Cross-Sectional Studies; D016208:Databases, Factual; D005260:Female; D005858:Germany; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D016743:Mental Competency / Q000331:legislation & jurisprudence*; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data*; D012149:Restraint, Physical / Q000706:statistics & numerical data; D012559:Schizophrenia / Q000175:diagnosis / Q000188:drug therapy; D014754:Violence / Q000706:statistics & numerical data*
keywords: Seclusion and restraint; Violence/aggression; involuntary treatment; legislation