Das letzte Mittel? Ein Überblick über die politische Diskussion und den Forschungsstand zum Einsatz medikamentöser Zwangsbehandlung in der Psychiatrie

The discussion on the use of compulsory drug treatment is reignited by changes in legal regulations. The following ar- ticle introduces the aspects of the legal framework, outlines core positions of the ongoing political discussion, and by following empirical studies considers questions on how frequently compulsory drug treatment is used, how it is ex- perienced and valued by those affected, and whether it is provably effective. Epidemiological studies show that the frequency of compulsory drug treatment varies considerably in Germany and internationally. Qualitative data in different contexts suggest that forced medication is associated with fear, anger, shame, and helplessness for many of those af- fected and can be traumatizing. Retrospective studies show that forced medication is evaluated as the right treatment in hindsight by about half of those affected. Robust empirical evidence for an immediate or long-term effect of forced medi- cation with regard to aggression, agitation, and symptoms is absent. Therefore, from an empirical point of view compul- sory treatment appears to be rather not justified. However, methodologically sound studies are difficult to conduct for ethical reasons. Furthermore, due to the variations in preva- lence it is doubtful whether the room to waive compulsion and to apply milder agents has been sufficiently utilized in all clinics. Promising approaches for the prevention of com- pulsory treatments lie in a stronger outreach treatment, the systematic use of milder agents in crisis situations, treatment agreements, and the development of psychological treatment alternatives. The potential of such alternatives should be used and explored more rigorously.