Use of Coercion in Psychiatric Services in Germany

Abstract

The use of different aspects of coercion in mental healthcare currently is under discussion in terms of ethics, clinical practice, human rights, and legal regulations. The author gives an overview on the current situation in Germany. Rates of involuntary admissions have been rising within the past 15 years due to different reasons while quotas (percentages of admissions) have remained unchanged. Nationwide data on the use of seclusion and restraint are not yet available, but data from some hospital groups, showing a big variance between hospitals as known from other countries. Involuntary outpatient treatment has never been legalized in Germany. The use of involuntary medication for in-patients has been considerably restricted since a decision of the Constitutional Court in 2011, requiring an independent expert review and a separate decision by a judge. There is evidence that the temporaneous inadmissability of involuntary medication led to an increase of seclusion and restraint. Changes in legislation in the Mental Health Acts of the 16 Federal states are under way, focusing more than previously on aspects of patient's autonomy and a balanced and limited use of coercive measures. The financing system for psychiatric hospitals to be introduced within the next years probably will be an obstacle for a further reduction of the use of coercion.