Aim: A series of legal regulations on the use of coercive measures in psychiatry initiated a vivid medico-ethical debate during the last year. The changed legal bases now require the use of alternatives before applying coercion as a "last resort". In this study we investigated whether and which alternatives are applied by psychiatrists in order to prevent coercive measures in general psychiatric hospitals and which factors are associated with their application. Methods: A sample of 343 psychiatrists was recruited by contacting psychiatric hospitals throughout Germany. In an online-survey attitudes to coercive measures and the use of alternatives to coercion were assessed by self-report. Results: Before initiating their most recent coercive measures almost half (46 %) of the participants employed only 2 or less alternatives. Patient related, individual and structural factors were reported as reasons for the failure of such measures. The use of alternatives was associated with a more positive assessment of their effectiveness as well as a more negative attitude towards coercive measures. Conclusion: Alternative measures are applied by many psychiatrists, but are not standard practice. Thus, there is a considerable room for improved practice.
