Research

Successful interventions on an organisational level to reduce violence and coercive interventions in in-patients with adjustment disorders and personality disorders

Tilman Steinert^1,2,4, Frank Eisele³, Ulla Goeser¹, Stefan Tschoeke¹, Carmen Uhlmann² and Peter Schmid²

¹  Centre for Psychiatry Weissenau, Clinical Department, Germany

²  Department of Psychiatry I, Ulm University, Ravensburg, Weingartshofer Str. 2, 88214 Ravensburg, Germany

³  Centres for Psychiatry Südwürttemberg, Data Management, Germany

⁴  Zentrum für Psychiatrie Weissenau, Dept. Psychiatry I, Ulm University, Postfach 2044, D 88190 Ravensburg-Weissenau, Germany

Clinical Practice and Epidemiology in Mental Health 2008, 4:27doi:10.1186/1745-0179-4-27

Published:	17 November 2008

Abstract

Background

Self-directed and other violence as well as subsequent coercive interventions occur in a substantial proportion of patients with personality disorders during in-patient treatment. Different strategies may be required to reduce coercive interventions for patients of different diagnostic groups.

Methods

We specialised one of our acute admission wards in the treatment of personality disorders and adjustment disorders (ICD-10 F4 and F6). Patients are not transferred to other acute wards in case of suicidal or violent behaviour. Violent behaviour and coercive interventions such as seclusion or restraint were recorded in the same way as in the rest of the hospital. We recorded the percentage of subjects affected by diagnostic group and average length of an intervention in the year before and after the change in organisational structure.

Results

The total number of coercive interventions decreased by 85% both among patients with an F4 and those with an F6 primary diagnosis. Violent behaviours decreased by about 50%, the proportion of involuntary committed patients decreased by 70%.

Conclusion

The organisational change turned out to be highly effective without any additional cost of personnel or other resources.