Consequences of the temporaneous lack of admissibility of involuntary medication in the state of Baden-Wuerttemberg: not less drugs, but longer deprivation of liberty

Abstract

After the decisions of the German Federal Constitutional Court in 2011 and the Federal Supreme Court in 2012, involuntary treatment was not approvable for a period of seven months in the State of Baden-Wuerttemberg. Previous analyses of routine data had demonstrated that at that time in a rather small group of patients, aggressive incidents and coercive interventions had significantly increased and then decreased to the previous level after the new legislation came into force. The changes concerned a relatively small group of involuntary patients. Based on an analysis of medical charts in 6 hospitals, this study aimed to investigate 1) whether refusal of prescribed medication became more frequent in that period and 2) how frequently antipsychotic medication was administered without coercion. We conducted a longitudinal intra-individual comparison and included all of the patients with schizophrenic and manic disorders who had been admitted in the period without the option of involuntary treatment and in a defined control period one year before as well (N = 174). Thus, study group and control group were identical. In the period without the option of involuntary treatment, patients remained involuntarily committed significantly more frequently (+ 26 %) but only insignificantly longer. Length of stay and number of mechanical restraints remained unchanged, number of seclusions doubled, and some patients could not leave the ward for long periods of time and had frequent readmissions. Persistent refusal of prescribed medication was significantly more frequent (+ 130 %, p < .001). However, the percentage of patients who received an antipsychotic drug during their hospital stay did not differ (96.0 vs. 96.6 %). The dosage at discharge as calculated in chlorpromazine units tended to be even higher during the period without option of involuntary treatment (+ 7.9 %, p = .06). All differences concerned both voluntary and involuntary patients. Without the option of involuntary treatment, persistent refusal of medication and different forms of deprivation of liberty increased. Nevertheless, oral antipsychotic treatment was realized in nearly all cases until discharge.