Neugestaltung einer Akutpsychiatrie – ein Werkstattbericht

Coercive interventions are part of the clinical work on psychiatric acute wards, despite efforts to avoid them. Their use is influenced by different factors in the preclinical, outpatient and inpatient sectors. In this article, based on clinical experiences in an acute inpatient unit approaches are suggested and discussed, which can contribute to reduce coercion in psychiatry. These include apart from improved hospital architecture, the implementation of integrated, cross-sectoral, low-threshold, flexible and individually adapted treatment systems (such as integrated care and crisis intervention teams), a sufficient number of personnel trained in complex de-escalating communication and interaction strategies that provide a broad therapeutic concept, peer workers, debriefing measures, joint crisis plans and close cooperation with stakeholders inside and outside the hospital. Furthermore, it is important to critically discuss the insufficient facilities to place patients in open or closed sheltered accommodation with healthcare authorities. Although coercive measures cannot be totally avoided, a critical and responsible debate about their use and handling is necessary, as well as long-term integrated therapeutic inpatient and outpatient care systems. These require appropriate allocation of staff and continuous treatment across different healthcare sectors. Moreover, if measures to reduce coercion are to be successful, the attitude of the therapeutic team is crucial.