The moral difficulties of adopting force or restraint in mental health care revolve around a profound social challenge: how to balance the need for humane treatment with the need for care. This tension between protecting individual rights and ensuring the well-being of patients and carers is heatedly debated and highlights the key need for innovative approaches to psychiatric interventions. These approaches must be centered on respect and compassion. As we explore this critical issue, it is clear that a joint effort is underway to change psychiatric care and clarify the subtle interaction between ethical principles and the practicality of providing mental health treatment.
To improve psychiatric care practices, an important study detailing the Lancet regional health – Europe, led by Professor Tilman Stanter of Ulm University, set out to study mandatory measures aimed at reducing the use of 55 psychiatric patients implementation of the guidelines. – Member units in Germany. This ambitious research initiative stands out with its comprehensive approach and external consultants to facilitate the implementation of guidelines, resulting in subtle findings that enrich our understanding of clinical practice of psychiatric care.
Professor Stannert shared in reflecting on the goals of the study: “The main result of the PreadCo study is that we cannot demonstrate that interventions aimed at improving guidelines adherence to the primary outcome measures, which is a significant impact, i.e., used in this guidance Frequency, i.e. the frequency used in this guide to attend the ward. “However, the main reason for this negative finding is that the median mandatory measures used decreased by 45% from baseline until the intervention expectations of the intervention ward ended, but It also dropped 28% in the waiting list ward. This may be due to the observer effect, while at the same time, mandatory use of psychiatric hospitals in Germany has increased during the Covid-19 pandemic. Despite the reduced challenging goals of mandatory measures, the study has made significant progress in other areas of psychiatric care practices.
A notable success of this study was a significant improvement in guidelines for intervention wards measured by the PreadCo rating tool. Professor Steinert observed: “In the intervention group a year later, team performance in guidelines implementation was significantly better.” The results suggest a positive shift to structured interventions and show that external consultants are promoting this Potential for changes in clinical practice.
This study also demonstrates the ongoing journey of more ethical, patient-centered psychiatry. The insights collected from this study provide a solid foundation for future exploration, highlighting the need for continuous innovation to minimize coercion by psychiatrists. Professor Steinert appropriately concluded: “Further research from a strong RCT that is sufficiently motivated to identify effective interventions to reduce mandatory use in psychiatric hospitals.” The call for action highlights the promotion of patient care and maintenance of individuals in psychiatric settings commitment to dignity and rights. Overall, the research led by Professor Tilman Steinert and his team, while navigating the complexity of implementing change in psychiatric care practices, has given valuable insights into efforts to reduce coercion. Its discovery and advances in guidelines are a beacon for future research, paving the way for further improvements in psychiatric care, respecting the rights and dignity of all patients.
Journal Reference
Steinert, T. wait. (2023). “Guidelines for the Prevention of Coercion and Violence (PEVCO) in Psychiatry: A Multicenter Randomized Controlled Trial.” Lancet Regional Health – Europe, 35, 100770. doi: https://doi.org/10.1016/j.lanepe.2023.100770
About the Author
Tilman Steinert He is a professor of psychiatry and psychotherapy at Ulm University in Germany and director of the Weisenau Psychiatric Clinic at Sudwatberg Psychiatric Center. He is a member of the European Violence and the European Fostren Network of the Psychiatry Research Group, and is used to study the use of coercion in psychiatry. He has been conducting research on violence and coercion since the early 1990s and has published more than 200 articles in peer-reviewed journals (see PubMed.ncbi.nlm.nih.gov/?term = steinert+steinert+t&sort = date) and several books, as well as several books, and are reviewers for many psychiatric journals and funding agencies. He also served as an expert witness on moral and coercive issues in the Federal Constitutional Court of Germany. His main research interests are epidemiology and subjective experience of coercion, psychiatry, violence, borderline personality disorder and schizophrenia.
Sophie Hirsch is a senior psychiatrist in the Department of Psychiatry and Psychology of Germany. She studied medicine and economics at Tuebingen and Hagen/Germany, and participated in advanced training and studied for psychiatry specialist at the South Wuerttemberg Psychiatry Center and Eberhard-Karls-Karls-University and Hertie Hertie Brain Institute in Shiro-Oncology of Sphity Trainity tuebingen. She is a member of the Board of Directors of the European Psychiatry Research Group (EVIPRG) and a member of the European Fostren Network for the use of stress in psychiatry. She was involved in the development of aggressive behaviors in Germany in coercion prevention and psychological care, as well as a nationwide multicenter RCT to implement the implementation of clinical routine ward guidelines.
Lieselotte Mahler He is the director of the psychiatric department of Theodor-Wenzel-werk Clinic in Berlin. She is the leader of the Social Psychiatry and Health Services Research Group in Charité Berlin’s Department of Psychiatry and Neuroscience and has conducted more than 10 years of research on acute psychiatric stress. Lieselotte Mahler has published many articles in peer-reviewed journals (see and several books). In particular, she developed the “Weddinger Modell,” a recovery-oriented concept of psychiatric disorders that significantly reduces stress measures, as well as standardization Standardization of post-urinary correction with patients’ review guidelines, which are well evaluated in reducing mandatory negative consequences.
Dorothea Sauter is a nurse and health scientist, MSC. She is currently the head of nursing development at LWL-Klinikum Münster. She is the president of the German Society of Psychiatric Nursing, the first editor of the German core textbook on psychiatric nursing, and a partner in the transfer magazine “Psychiatric Patients”. As a nurse, nurse manager, teacher and researcher, as well as consultants and experts, she deals with the reduction of coercive measures and the implementation of complex interventions in a number of different ways.
