Coercion in Psychiatric Services in Switzerland

Abstract

The use of different aspects of coercion in mental healthcare currently underlies extensive ethical, legal and professional discussionsand aspects of clinical practice have been changing within the last decade. Based on available evidence and knowledge of legislation and politicaldiscussions, an overview is given on the following aspects in Switzerland:1. changes in legislation withinthe last decade2. involuntary admissionprocedures3. involuntary outpatienttreatment4. use of involuntary medication5. use of seclusion, restraint, and other containment measures6. changes in clinical practice7. expected developmentsIn 2013 a new legislation concerning several aspects of involuntary admission, mandatory treatment and legal guardianship has been introduced in Switzerland(Kindes- und Erwachsenenschutzrecht, KESR). The revision of relevant chaptersof the civil code led to various discussions among mental health professionalsand on a societal level about the implications on clinical practice and qualitymanagement. Before the introduction, formal and factual criteria as well asprocedures of involuntary admission varied considerably between cantons, regions and authorities. Attitudes of mental health professionals and thegeneral population towards psychiatric patients and involuntary treatmentpractices are intertwined with the legislation. The effects of the new legislation concerning admission procedures, treatment practices and staff attitudes are discussed. Measures of involuntarytreatment have been introduced in basic documentation (PSYREC) on a nationallevel in 2012. Evaluations of changes in clinical practice associated withalterations in legislation are needed.