Coercive Treatment Research Articles

Thomas Wentworth’s Irish electoral strategy, 1634

ABSTRACT Thomas Wentworth (1593–1641) came to the Lord Deputyship of Ireland with a background in Yorkshire and English politics. His ruthless, divisive and barely legal electioneering in Yorkshire was always on behalf of fellow members of the local gentry and invoked class issues. His behaviour during his time as President of the Council of the North prefigured his government of Ireland. Wentworth’s 1634 Irish election campaign built on his predecessors’ strategies, sending conciliatory signals to Catholics while conducting a strong operation, in defiance of the king’s orders, for the return of officials, soldiers and his own dependents, many of a lower social class and unconnected with their constituencies. He relied heavily on Irish privy councillors for the success of his campaign and lied to English politicians about the election results and parliamentary proceedings. His coercive treatment of parliament and its members during and after the sessions and his ruthless favouring of his clients and vindictive treatment of those who opposed him led him to over-reach himself and set a course for his downfall and execution.

Weather and Aggressive Behavior among Patients in Psychiatric Hospitals-An Exploratory Study.

Background: The number of meteoropaths, or people negatively affected by weather conditions, is rising dramatically. Meteoropathy is developing rapidly due to ever poorer adaptations of people to changes in weather conditions. Strong weather stimuli may not only exacerbate symptoms in people with diseases of the cardiovascular and respiratory systems but may also induce aggressive behavior. Researchers have shown that patients suffering from mental illnesses are most vulnerable to changes in the weather and postulate a connection between the seasons and aggressive behavior. Methods: The goal of the study was to analyze the relationship between coercive measures and weather factors. The researchers identified what meteorological conditions prevailed on days with an increased number of incidents of aggressive behavior leading to the use of physical coercion towards patients in a psychiatric hospital in Poland. In order to determine the impact of weather conditions on the frequency at which physical coercion measures were used, the hospital’s “coercion sheets” from 1 January 2015 to 31 March 2017 were analyzed. The data were correlated with meteorological data. In order to determine the relationship between the occurrence of specific weather conditions and the number of coercive interventions (N), researchers utilized Spearman’s rank correlation analysis together with two-dimensional scatter diagrams (dependency models), multiple regression, stepwise regression, frequencies, and conditional probability (%). Results: Lower barometric pressure and foehn wind increased aggressive behavior in patients that led to coercive measures. For temperature (positive correlation) and humidity (negative correlation), there was a poor but statistically significant correlation. Conclusions: Monitoring weather conditions might be useful in predicting and preventing aggression by patients who are susceptible to weather changes

Use of the Safewards Model in healthcare services: a mixed-method scoping review protocol

IntroductionSafewards is an organisational approach to delivering inpatient mental health services. The aim of Safewards is to minimise the number of situations in which conflict arises between healthcare workers and...

Effect of standardized post-coercion review session on symptoms of PTSD: results from a randomized controlled trial

ObjectivePost-coercion review is increasingly regarded as a mean to reduce the negative consequences of coercive interventions, including the development of posttraumatic symptoms. However, the efficacy of this intervention in preventing posttraumatic symptoms or PTSD has not been sufficiently studied. The objective of this study is to examine the influence of a single, standardized post-coercion review session on the development or exacerbation of PTSD symptoms in patients with psychotic disorders.MethodsIn a multi-center, two-armed, randomized controlled trial, patients who experienced coercive interventions during current hospitalization were either randomized to standard treatment or an intervention group receiving a guideline-based, standardized reflecting review session. Factorial MANCOVA and subsequent ANCOVAs investigated the effects of the post-coercion reflecting review session on post-traumatic symptoms as measured by the subscales of the Impact of Events Scale-Revised (IES-R). Similarly, the effect of the intervention on the intensity of the peritraumatic reactions measured by the Peritraumatic Distress Inventory (PDI) was analyzed by conducting a factorial ANCOVA.ResultsN = 82 patients were included in an intention-to-treat analysis. MANCOVA and post hoc ANCOVAs revealed a significant main effect of the intervention for the IES-R subscales intrusion and hyperarousal, when controlling for levels of peritraumatic distress, whereby intervention group participants presented lower respective mean scores. There was no significant difference regarding the intensity of the peritraumatic reaction.ConclusionStandardized post-coercion review contributes to a reduction of the burden of PTSD symptoms in patients with psychotic disorders experiencing coercive interventions in acute settings and shall be recommended as a measure of trauma-informed care.The trial was registered at ClinicalTrials.gov (ID NCT03512925) on 01/30/2018 (retrospectively registered).

Under which conditions are changes in the treatment of people under involuntary commitment justified during the COVID-19 pandemic? An ethical evaluation of current developments in Germany

The COVID-19 pandemic poses significant challenges in psychiatric hospitals, particularly in the context of the treatment of people under involuntary commitment. The question arises at various points in the procedure for and process of involuntary commitment whether procedural modifications or further restrictive measures are necessary to minimise the spread of COVID-19 and protect all people involved from infection.In the light of current developments in Germany, this article examines under which conditions changes in the treatment of people under involuntary commitment are ethically justified in view of the COVID-19 pandemic. Among others, we discuss ethical arguments for and against involuntary commitments with reference to COVID-19, the use of different coercive interventions, the introduction of video hearings, an increased use of video surveillance and interventions based on the German Infection Protection Act.We argue that strict hygiene concepts, the provision of sufficient personal protective equipment and frequent testing for COVID-19 should be the central strategies to ensure the best possible protection against infection. Any further restrictions of the liberty of people under involuntary commitment require a sound ethical justification based on the criteria of suitability, necessity and proportionality. A strict compliance with these criteria and the continued oversight by external and independent control mechanisms are important to prevent ethically unjustified restrictions and discrimination against people with the diagnosis of a mental disorder during the COVID-19 pandemic.

Monitoring risk assessment on an acute psychiatric ward: Effects on aggression, seclusion and nurse behaviour.

Evidence of risk assessment procedures is scarce and inconclusive. The aim of this study is to evaluate the effects of risk assessment on aggression and the use of coercive interventions in an acute psychiatric admission setting. In addition, we evaluated nurse behaviour before and after the use of risk assessment. To take the fluctuations with regard to aggression and coercive interventions into account, we allowed 26 weeks for baseline measurements, followed by a 26 weeks steady-state period after the implementation of the risk assessment instrument. Contrary to expectations, no positive effects of risk assessment were found on aggression or on coercive interventions. Time spent in seclusion increased significantly with more than 10 hours on average after implementation. Furthermore, there were only negative effects on nurse behaviour and experiences. Among other things, they felt more stressed, spent more time on administration tasks and spent less time with patients after the implementation. In conclusion, there is insufficient evidence to use structured short-term risk assessment to reduce aggression or coercive interventions.

Efficacy of interventions to reduce coercive treatment in mental health services: umbrella review of randomised evidence.

Coercive treatment comprises a broad range of practices, ranging from implicit or explicit pressure to accept certain treatment to the use of forced practices such as involuntary admission, seclusion and restraint. Coercion is common in mental health services. To evaluate the strength and credibility of evidence on the efficacy of interventions to reduce coercive treatment in mental health services. Protocol registration: https://doi.org/10.17605/OSF.IO/S76T3. Systematic literature searches were conducted in MEDLINE, Cochrane Central, PsycINFO, CINAHL, Campbell Collaboration, and Epistemonikos from January 2010 to January 2020 for meta-analyses of randomised studies. Summary effects were recalculated using a common metric and random-effects models. We assessed between-study heterogeneity, predictive intervals, publication bias, small-study effects and whether the results of the observed positive studies were more than expected by chance. On the basis of these calculations, strength of associations was classified using quantitative umbrella review criteria, and credibility of evidence was assessed using the GRADE approach. A total of 23 primary studies (19 conducted in European countries and 4 in the USA) enrolling 8554 participants were included. The evidence on the efficacy of staff training to reduce use of restraint was supported by the most robust evidence (relative risk RR = 0.74, 95% CI 0.62-0.87; suggestive association, GRADE: moderate), followed by evidence on the efficacy of shared decision-making interventions to reduce involuntary admissions of adults with severe mental illness (RR = 0.75, 95% CI 0.60-0.92; weak association, GRADE: moderate) and by the evidence on integrated care interventions (RR = 0.66, 95% CI 0.46-0.95; weak association, GRADE: low). By contrast, community treatment orders and adherence therapy had no effect on involuntary admission rates. Different levels of evidence indicate the benefit of staff training, shared decision-making interventions and integrated care interventions to reduce coercive treatment in mental health services. These different levels of evidence should be considered in the development of policy, clinical and implementation initiatives to reduce coercive practices in mental healthcare, and should lead to further studies in both high- and low-income countries to improve the strength and credibility of the evidence base.

Ferguson v. City of Charleston Redux: Motivated Reasoning and Coercive Interventions in Pregnancy.

Criminalization of perinatal substance use disorder and other coercive interventions in pregnancy (such as forced cesarean delivery or involuntary hospitalization for bed rest) directly affect the well-being of children and their families and, potentially, of all women of reproductive capacity. Untenable legal and policy approaches that occasion such incursions not only persist but affect a growing number of women. They are antithetical to healthy pregnancies, healthy children, and healthy families; they have the potential to reduce prenatal care seeking, divert attention and resources away from critical mental health and maternal and child support services, and epigenetically affect maternal and infant bonding. Punitive and coercive interventions contravene long-established guidance by professional associations that advocate for public health approaches and ethical frameworks to guide practice. Harmful policies persist because of motivated reasoning by clinicians, members of the judiciary, and ill-informed legislators who rely on personal experience and anecdote rather than evidence to fashion policy. Compounding the problem are inadequate substance use treatment resources and professional associations that choose not to hold their members accountable for violating their ethical obligations to their patients. Pediatricians must advocate for the cessation of coercive interventions within their institutions and their larger communities. All health care professionals should collaborate at the local, state, and national level to provide policymakers and legislators with data emphasizing the negative effects of punitive and coercive policies aimed at pregnant women and their children.

Student Misbehaviour and School Climate: A Multilevel Study

espanolEsta investigacion examina en que medida la percepcion del profesorado sobre el comportamiento disruptivo correlaciona con la percepcion del clima escolar y los autoinformes del alumnado, mediante una modelizacion multi-informante y multinivel. Los cuestionarios sobre el clima escolar, cumplimentados por 4,055 profesores y 16,017 estudiantes (de 1o a 4o curso de Educacion Secundaria Obligatoria pertenecientes a 187 centros educativos), muestran que las caracteristicas de los profesores se relacionan solo marginalmente con la disrupcion percibida. La existencia de unas reglas justas y el apoyo de las familias de los estudiantes se mostraron como factores de proteccion, mientras que la ausencia de un adecuado liderazgo en el equipo directivo aparecia como factor de riesgo. Ademas, los mensajes que los alumnos reciben de sus padres a favor de la violencia actuaron como moderadores del liderazgo y las reglas, mientras que el trato coercitivo de los profesores que percibian los estudiantes actuo de moderador del apoyo de la familia hacia el profesorado. EnglishThis study examines how teacher perceptions of student misbehaviour correlate with their perceptions of school climate and student self-reports, using multi-informant two-level multilevel modelling. School climate questionnaires completed by 4,055 teachers and 16,017 students (1rd to 4th year of compulsory secondary education from 187 schools) showed that teachers’ characteristics are marginally related to perceived disruption. Fair rules and support of students’ families acted as protective factors, while a lack of educational leadership was a risk factor. Furthermore, the student variable of pro-violence messages from parents acted as a moderator for leadership and rules, while perceived coercive treatment from teachers acted as a moderator for family support of teachers

The misuse of “duty of care” as justification for non-consensual coercive treatment

The duty of care concept is a common law legal principle which underpins all healthcare interactions. However, evidence within the Australian context suggests misuse of this common law principle as a justification for non-consensual coercive treatment. Misuse seems to occur particularly where patients have impaired decision-making capacity and/or refuse treatment. In this article, we discuss the emerging evidence of misuse, which arguably reflects healthcare practitioner confusion between the doctrines of ‘duty of care’ and ‘necessity’, and posit that cognisance of lawful substitute consent processes are lacking. We then discuss the concept of duty of care as an obligation, as opposed to a power, before presenting the elements of a valid consent and legislation relating to substitute consent, which allow health practitioners to proceed with treatment. We conclude this article with a discussion of the circumstances where treatment may be given without consent.

Supplier Engagement in Sustainability Programs: A Field Experiment of Enabling Versus Coercive Formalization

Formal, compliance-focused governance for supply chain sustainability initiatives has a mixed empirical track record. We build on classic research on bureaucracy to examine how “enabling” and “coercive” formalization at the buyer–supplier interface affect attitudes, an important precursor to behavioral engagement. We conduct a randomized field experiment with the supplier community of a South African insurance company to directly compare treatment effects of enabling and coercive interventions. We report and discuss the enabling intervention’s positive attitudinal effects and the moderation of these effects by supplier characteristics. Our findings also reveal some notable null effects, especially from the coercive intervention. We believe this work contributes to a more nuanced understanding of formal governance choices in supply chains and their impact on supplier engagement.

Coercion in psychiatry: A cross-sectional study on staff views and emotions.

WHAT IS KNOWN ON THE SUBJECT?: Coercive interventions (CI) in emergency psychiatry face increasing criticism, as they can be an emotional, even traumatic event for all persons involved. They are thus considered the last resort. The use of coercive interventions differs widely with regard to type and frequency of measures across different countries and institutions. Individual staff characteristics, such as attitudes towards coercion, may play a vital role in the management of aggression. Little is known about the influence of emotions of staff members on CI, but they are likely to play an important role. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: Most staff members surveyed had a rather critical view of coercion and considered it a "necessary evil." Staff members with the most work experience had a more critical view of coercion in comparison with less experienced staff. Nurses rated coercion more positively than did psychiatrists or psychologists. Emotions play an important role in decision-making processes. The current study systematically asked for accompanying emotions during the application of CI and looked for individual differences. A majority of the participants experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% stated that they felt a sense of power. Older staff members more often felt anger or guilt; women felt less power than men did. Nurses felt more desperation than other occupational groups. Staff members consider reflective interventions, such as team supervisions or post-seclusion/restraint debriefings with the patient, as important. Nevertheless, only half reported that these interventions are carried out routinely. Staff members believe that certain risk factors (including stress, low staffing, a fully occupied ward and the presence of particular staff members) enhance the probability of CI. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: To reduce the use of coercive interventions, we recommend that psychiatric teams include highly experienced staff members as work experience has a positive effect on the attitudes towards coercive interventions. Structured post-seclusion/restraint debriefings and team supervisions are considered helpful by staff members and are relatively easy to implement on acute wards. Enhancing staff members' ability to reflect on their own attitudes, emotions and actions is likely to reduce coercive interventions. ABSTRACT: Introduction Little is known about staff attitudes towards coercive interventions (CI) and emotions accompanying these measures. Aim The current study assessed attitudes, views on reflective interventions and accompanying emotions of different occupational groups towards CI, as well as factors, that increase the probability of CI. Method Staff members (N=138) of a large psychiatric hospital in Germany were assessed using the Staff Attitude to Coercion Scale (SACS) and newly developed items assessing staff members' emotions and views on coercion. Results Experienced staff members were most critical of coercion. Nurses rated coercion significantly more positively than other staff. A majority experienced compassion; about half felt helplessness, grief or anxiety. Almost 20% felt a sense of power. Nurses felt the most desperation. Participants strongly desired reflective measures such as post-seclusion/restraint debriefings with patients. According to staff members, stress on the wards and low staffing increases the probability of CI. Discussion The study assessed accompanying emotions during the application of CI. Attitudes towards coercion and emotions are associated with individual staff characteristics (e.g. profession, work experience). Implications The presence of experienced staff members may help prevent CI. Staff consider reflective interventions helpful in reducing CI.

S224. TREATMENT IN THE PSYCHOSIS FIRST EPISODE PROGRAM “ZüRCHER ERSTPSYCHOSEN NETZWERK (ZEN)”: QUALITY CONTROL OF THE OUTCOME

BackgroundThe treatment in the years following a first-psychosis episode is most crucial as typically, the illness onset occurs in a delicate phase of the young adults (Correll, 2018).To address the specialities in the care for this patient population both, the Child and Adolescent, together with the adult department of the Psychiatric University Hospital Zürich implemented the ZEN psychosis first episode program.Members of the specialized team connected in their function as network coaches in a systemic approach all players of the patient’s social and medical network. The better communication on transition points such as to adult department, together with possibilities of low-threshold treatment, aimed to improve treatment adherence and reduce repeated hospitalisations.The study’s main objective was to evaluate the efficacy of the program and with that optimize the treatment process in daily clinical routine. A jurisdictional inquiry has been requested by Swiss Ethics Committees on research involving humans in Zurich and the present study project is classified as quality control of the clinical treatment.MethodsParticipants of the ZEN Program included in 2017 and 2018 were followed up to duration of 24 months. The following measures were assessed before and after enrolment in the program: Satisfaction with life, measured with the Manchester Short Assessment of Quality of Life (MANSA; Priebe et al., 1999); Number of rehospitalisations and coercive treatment; Global assessment of functioning (GAF) (Endicott et al., 1976); and measures of Social and vocational recovery.ResultsIn Florence, results and implications will be presented for included patients.Rates of rehospitalisations will be compared against literature. Mean relaps rates at 24 months have been reported to vary from 38% under specialized integrated care, to up to 49% under treatment as usual (Fusar-Poli et al., 2017).Social and vocational recovery will be rated at follow-up and compared to baseline on a three-point scale (‘no’, ‘partial’ and ‘full’ recovery) (Craig et al., 2004, Garety et al., 2006).In addition, correlation coefficients will be determined to detect any associations among sociodemographic factors and clinical data such as amount of neuroleptic medication.DiscussionThe ZEN program is specialized for patients with first episode of psychosis. The intensive care together with an intensified communication between players of a patient’s network aims to achieve better outcomes. The evaluation of the clinical program is of importance. The study provides recent data for ongoing discussions about the quality of the treatments and its cost-effectiveness compared to standard treatment.

Ulysses Coercion Through Psychiatric Advanced Directives in Homeless People With Substance Use Disorder: A Qualitative Study of the Colombian Perspective

Homeless substance users (HSUs) represent a public health challenge given their high social impact and the numerous barriers they have to overcome to receive mental health treatment. Recent public debate in Colombia is concerned with how to approach HSUs within the health system. The aim of this publication was to explore the possibility of implementing Psychiatric Advance Directives (PADs) in HSUs as an alternative to coercive treatment, to favor substance abuse treatment adherence and service retention in this population. For this purpose, the authors conducted 3 in-depth interviews of individuals who previously experienced homelessness and were voluntarily admitted to an inpatient substance abuse treatment ward at the moment of the interview. This research indicates that substance abuse in homeless individuals does not imply an impairment of their mental or legal capacity. Moreover, restraining HSUs during intense craving episodes within inpatient settings by implementation of PAD does not seem to be a viable option given the multiple risks and challenges it poses to mental health care providers. Finally, the use of any coercive measure toward HSUs, and this type of PADs in particular, could potentially be associated with violent episodes or human rights violations within mental health institutions.

Predicting patient outcomes in psychiatric hospitals with routine data: a machine learning approach

BackgroundA common problem in machine learning applications is availability of data at the point of decision making. The aim of the present study was to use routine data readily available at admission to predict aspects relevant to the organization of psychiatric hospital care. A further aim was to compare the results of a machine learning approach with those obtained through a traditional method and those obtained through a naive baseline classifier.MethodsThe study included consecutively discharged patients between 1st of January 2017 and 31st of December 2018 from nine psychiatric hospitals in Hesse, Germany. We compared the predictive performance achieved by stochastic gradient boosting (GBM) with multiple logistic regression and a naive baseline classifier. We tested the performance of our final models on unseen patients from another calendar year and from different hospitals.ResultsThe study included 45,388 inpatient episodes. The models’ performance, as measured by the area under the Receiver Operating Characteristic curve, varied strongly between the predicted outcomes, with relatively high performance in the prediction of coercive treatment (area under the curve: 0.83) and 1:1 observations (0.80) and relatively poor performance in the prediction of short length of stay (0.69) and non-response to treatment (0.65). The GBM performed slightly better than logistic regression. Both approaches were substantially better than a naive prediction based solely on basic diagnostic grouping.ConclusionThe present study has shown that administrative routine data can be used to predict aspects relevant to the organisation of psychiatric hospital care. Future research should investigate the predictive performance that is necessary to provide effective assistance in clinical practice for the benefit of both staff and patients.

Cities and Dominance: Urban Strategies for Political Settlement Maintenance and Change – Zambia Case Study

This paper tracks how the Patriotic Front (PF) – Zambia’s main opposition from 2006 to 2011, when the party won power – shifted its strategies of dealing with the urban poor, civil society and the middle class, in order to manage its vulnerability. While all three groups fully supported the PF in 2011, they are now in a more ambivalent position, thereby creating insecurity for the ruling regime. We contextualize these dynamics vis-a-vis Zambia’s broader political landscape, from 2001 to date, relying on historical processing tracing, in-depth interviews with key elite actors and a survey with informal traders. Using the case study of the PF, the paper demonstrates how political settlements can deepen the analysis of how and why particular strategies for dominance emerge in a given context, where the threats to this dominance emerge, and why governing elites target particular groups for co-optive or coercive interventions. It concludes that, due to its size and influence, the PF’s hold on Lusaka is crucial to its survival past the 2021 elections. Consequently, it is anticipated the party will continue to exert repressive pressure on sources of countervailing power and opposition and co-opt poorer but numerically large support bases (e.g. marketeers and vendors)

Cooperation in the mental health treatment of patients with outpatient commitment

Background:Patients with outpatient commitment have a decision on coercive treatment from the specialist health services even if they are in their own home and receive municipal health services.Objective:The aim of this study is to gain more knowledge about how the outpatient commitment system works in the municipal health service and specialist health services, and how they collaborate with patients and across service levels from the perspectives of healthcare professionals.Methods:This is a qualitative study collecting data through focus group interviews with health personnel from the municipal health service and specialist health services.Results:The results describe the health personnel’s experiences with follow-up and interactions with the patients with outpatient commitment decisions, and their experiences with collaboration between service levels.Conclusion:The study show that outpatient commitment makes a difference in the way patients with this decision are followed up. The legislative amendment with new requirements for consent competence was challenging. Collaboration between services levels was also challenging.

Preaching Phrenitis: Augustine’s Medicalization of Religious Difference

Like many late antique preachers and theologians, Augustine of Hippo understood deviant religious practices and beliefs in terms of mental illness. Whereas this metaphor was typically framed in generic terms (for example, “madness” or “insanity”), Augustine developed a consistent and specific diagnosis that made use of the symptoms of the mental illness phrenitis (acute delirium with acute fever) to undermine the self-knowledge and authority of those who thought their spiritual health did not depend upon the healing intervention of Christ or his substitute, the Christian preacher. This article argues that Augustine used the mental illness phrenitis as a model for sickness of the soul in order to reinforce his own authority as a physician of the soul and to justify coercive therapeutic interventions in the lives of his opponents. Phrenitis represented for Augustine a sickness characterized by distorted self-perception, the rejection of medical care, preternatural physical strength, and a tendency to violence. These symptoms, which were rooted in the medical concept of the disease, established a framework for his medicalization of religious difference, both at the local level (congregants, religious opponents) and on a broader theological plane. This medicalization motivated strategies of therapeutic coercion, and enabled Augustine to define his ecclesial community along therapeutic lines.

Physical restraint using, autonomy, ethics among psychiatric patients in nursing practice in China

The application of physical restraint for patients represents ethical dilemmas for psychiatric nurses in terms of maintaining the safety of all (clients and staff) while at the same time curtailing the individual's autonomy. This article aimed to provide a sound knowledge of ethical positions and strategies for psychiatric nurses to address ethical issues of physical restraint according to the ethical principles of autonomy, beneficence, nonmaleficence, and ethical theories. Given that nursing workforce was limited and workload among psychiatric nurses was heavy, physical restraint was one of the coercive interventions managing aggressive behavior. In relation to address ethical dilemmas, it was proposed to acquire informed consent of physical restraint from the individuals and provide person-centered care. Effective communication and negotiation with patients could help to strike a balance between patients' autonomy and nurses' accountability when using physical restraint. In addition, guidelines and targeted intervention strategies need to be developed to regulate and reduce the implementation of restraint. Finally, a collaboration among nurses, psychiatrists, and families is essential to protect patients' autonomy concerning physical restraint use.

Reduction of coercive measures under routine conditions in psychiatric hospitals 2004-2019: Strong effects in old age psychiatry, much less in general psychiatry.

Many interventions to reduce the use of seclusion and restraint have been suggested in the last decades. Evidence-based interventions in old age psychiatry are different from those in general psychiatry. A common database for psychiatric hospitals introduced in 2004 allowed to examine the use of seclusion and restraint over 16years under routine conditions. A registry for coercive measures in the Federal State of Baden-Wuerttemberg has been available since 2015, and comprises all 32 hospitals licensed to admit involuntary patients. A study group had collected data prospectively since 2004 from a subsample of these hospitals. We analyzed the mean percentage of patients subjected to coercive measures and the mean cumulative duration of these interventions in ICD-10 diagnostic groups in psychiatric hospitals from 2004 to 2019 among a total of 1,038,239 admissions. The proportion of cases affected by coercive measures dropped significantly from 28.4 to 10.5% in patients with ICD-10 F0 disorders, while rates in patients with other diagnoses decreased insignificantly from 7.0 to 5.4%. The cumulated duration of coercive measures per affected case also dropped significantly among patients with F0 disorders, while changes in patients with other diagnoses remained insiginficant. The use of coercive measures in patients with organic disorders could be reduced by about 50% in a State of 11 million inhabitants within 15years, while in contrast no substantial reduction occurred among all other diagnostic groups. Specific interventions to reduce coercive interventions seem to be particularly successful for this patient group.