Overcoming the lack of alternatives - Changes in the use of coercive measures after implementation of the recovery-oriented "Weddinger Modell" in acute psychiatric care.

Abstract

Introduction: Due to the ethical conflict potential and far-reaching negative consequences of coercive measures (CM) in acute psychiatry, approaches to reduce the use of CM are investigated increasingly. One approach is the recovery-, resilience-, and patient-centered "Weddinger Modell" (WM) for inpatient psychiatric care. The present study evaluates the WM and investigates whether cases affected by CM, cases affected by seclusion or restraint, and the number, total duration, and average individual duration of CM per case are significantly reduced after WM-implementation.

Methodology: This is a retrospective study based on data from patient records. The main implementation phase of the WM (WM-MIP) was defined as the period between May and August 2020. Cases treated between July 2019 and June 2021 were included. To compare changes in the use of CM before and after the WM-MIP, different multilevel regression models were applied (with n = 1656 cases and n = 194 cases affected by CM, respectively).

Results: Cases affected by seclusion and the number of CM per case were significantly reduced after WM-MIP. No significant difference was found in terms of CM affected (total) or restraint affected, total CM duration, and average single CM duration per case.

Discussion: The results indicate a positive effect of the WM with regard to the reduction of CM. In terms of further spread of the WM, the implementation process should be studied in detail, especially to identify key components to reduce CM.

Conclusion: The WM should be considered as an approach to reduce CM.