Impact of the Temporaneous Lack of Legal Basis for Involuntary Treatment on the Frequency of Aggressive Incidents, Seclusion and Restraint among Patients with Chronic Schizophrenic Disorders

Objective: In the German federal state Baden-Wuerttemberg involuntary medication of detained psychiatric inpatients was unlawful during eight months from July 2012 until February 2013 due to a decision of the Federal Constitutional Court except for emergency situations. We examined whether aggressive incidents and mechanical coercive measures such as seclusion and restraint increased.

Methods: Routine data of 2.644 cases with schizophrenic and manic disorders in seven psychiatric hospitals were analysed by a pooled cross-section analysis as well as by a longitudinal analysis for the relevant time period and the corresponding period of the preceding year.

Results: The number of mechanical coercive measures and of aggressive incidents increased significantly by over 40 % in the cross-sectional analysis. In the longitudinal analysis which included only patients with admissions in both periods, the increase of both aggressive incidents and coercive measures was over 100 %. Effects on the duration of measures were insignificant.

Conclusions: The temporaneous impossibility to apply involuntary medication was associated with a significant increase of aggressive incidents, seclusion, and mechanical restraint.