Behandlungsvereinbarungen in der Psychiatrie – reale Praxis in einem Verbund psychiatrischer Kliniken

Abstract

Joint crisis plans (JCPs) are offered in many psychiatric hospitals, but patients only rarely make use of them. To assess the rates of JCPs among inpatients of mental health hospitals and to analyze the clinical characteristics of patients who make use of aJCP. We carried out aretrospective analysis of routine data from the statistical database/basis documentation of the LVR hospital association, which consists of nine psychiatric hospitals. The basis documentation is consistent in the nine hospitals. All admissions between 2016 and 2020 were considered. We recorded the existence of aJCP, age, gender and main diagnosis at release, as well as previous hospital stays, detention under the Mental Health Act of the Federal State of NRW and experiences with compulsory measures (seclusion/restraint) in the previous 24months before index admission. Out of atotal of 117,662 inpatients 467 (0.4%) had completed aJCP. Patients with JCP were more likely to be diagnosed with schizophrenia, bipolar disorder, or emotionally unstable personality disorder. Patients with aJCP had more previous inpatient stays and they had more frequently experienced detentions and compulsory measures. However, 50% of the patients with aJCP had other diagnoses and the vast majority of them had experienced no detention or compulsory measure in the 24months preceding the first documentation of aJCP. Overall, the use of JCPs is limited. The targeted group of patients with severe mental illness and previous experience with involuntary placements and compulsory measures make use of the offer of aJCP but so do other patients as well. Additional qualitative analyses are required in order to analyze the content and objectives of JCPs in more detail.