Abstract
Coercive treatment with antipsychotic drugs was commonly used in German psychiatric institutions until it became a topic of substantial medical, legal and ethical controversy. In 2011 and 2012, several landmark decisions by Germany’s Constitutional Court and Federal Supreme Court challenged this practice in all but life-threatening emergencies. In March 2013, the new legal provisions governing coercive treatment took effect allowing coercive medication under stricter criteria. While mainstream psychiatry in Germany resumed the use of coercive medication, although less frequently than before 2012, there are examples where clinicians put an even greater emphasis on consensual treatment and did not return to coercive treatment. Data from a case study in a local mental health service suggest that the use of coercive medication could be made obsolete.
Highlights
Coercive use of antipsychotic medication is common in psychiatric institutions and usually affects people with severe mental illness [1,2]
Prior to the Constitutional Court decisions of 2011, coercive medication could be administered to those patients being detained in psychiatric institutions under German mental health laws without an additional judicial procedure
Soon after the Constitutional Court rulings, some psychiatrists reported an increase in violence and other coercive measures in their hospitals as they felt unable to control their patients’ disruptive behavior when these patients objected to treatment with antipsychotic medication
Summary
Coercive use of antipsychotic medication is common in psychiatric institutions and usually affects people with severe mental illness [1,2]. While there is a remarkable absence of randomized trials on coercive antipsychotic treatment in hospitals, the use of community treatment orders has been studied in an experimental design in the UK and was found not to be effective in reducing relapse and readmission to hospital [3]. In 2011, Germany’s Constitutional Court declared the regulations on coercive treatment in two German states (Rhineland-Palatine and Baden-Wurttemberg, 2 BvR 882/09 and 2 BvR 633/11). Unlawful, which effectively stopped coercive antipsychotic treatment in these parts of Germany [4]. It was not the view of the Constitutional Court that coercive treatment per se was unconstitutional but rather that the criteria under which it could be given were far too wide.
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