Eva Krieger1,2, Rabea Fischer3,4, Steffen Moritz4, Matthias Nagel3,5. 1. Klinik für Psychiatrie und Psychotherapie, Asklepios Klinik Nord - Wandsbek, Jüthornstraße 71, 22043, Hamburg, Deutschland. eva.krieger@gmx.de. 2. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland. eva.krieger@gmx.de. 3. Klinik für Psychiatrie und Psychotherapie, Asklepios Klinik Nord - Wandsbek, Jüthornstraße 71, 22043, Hamburg, Deutschland. 4. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20251, Hamburg, Deutschland. 5. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Deutschland.
Abstract
BACKGROUND: Research on measures to prevent or reduce the use of coercive measures is steadily gaining momentum in research. Post-seclusion/post-restraint debriefings with the affected patients are recommended in treatment guidelines but the effectiveness as an intervention has so far only scarcely been studied. AIMS AND METHODS: This article briefly outlines the existing literature on post-seclusion/post-restraint debriefings, the legal basis in Germany, recommendations by various treatment guidelines as well as the existing evidence of the effectiveness. Furthermore, challenges pertaining to the implementation of debriefings are discussed. RESULTS: Various treatment guidelines recommend post-seclusion/post-restraint debriefings with patients and the individual Mental Health Laws (PsychKG) of the German federal states provide more or less specific guidance on how to implement the intervention. So far, hardly any scientific studies on the effectiveness of post-seclusion/post-restraint debriefings exist but they are already carried out in a variety of complex treatment concepts. Various parameters, e.g. who participates and when the debriefing is conducted, also vary across implementations. Initial pilot studies have shown indications for positive effects in terms of reducing coercive measures through the implementation of post-seclusion/post-restraint debriefings; however, structured debriefings are not yet part of routine practice. CONCLUSION: Structured post-seclusion/post-restraint debriefings with patients constitute a possible intervention to reduce coercive measures, but as of now there is little scientific evidence for the efficacy. Incorporating them into complex therapeutic treatment concepts for ward programs appears to be meaningful.
BACKGROUND: Research on measures to prevent or reduce the use of coercive measures is steadily gaining momentum in research. Post-seclusion/post-restraint debriefings with the affected patients are recommended in treatment guidelines but the effectiveness as an intervention has so far only scarcely been studied. AIMS AND METHODS: This article briefly outlines the existing literature on post-seclusion/post-restraint debriefings, the legal basis in Germany, recommendations by various treatment guidelines as well as the existing evidence of the effectiveness. Furthermore, challenges pertaining to the implementation of debriefings are discussed. RESULTS: Various treatment guidelines recommend post-seclusion/post-restraint debriefings with patients and the individual Mental Health Laws (PsychKG) of the German federal states provide more or less specific guidance on how to implement the intervention. So far, hardly any scientific studies on the effectiveness of post-seclusion/post-restraint debriefings exist but they are already carried out in a variety of complex treatment concepts. Various parameters, e.g. who participates and when the debriefing is conducted, also vary across implementations. Initial pilot studies have shown indications for positive effects in terms of reducing coercive measures through the implementation of post-seclusion/post-restraint debriefings; however, structured debriefings are not yet part of routine practice. CONCLUSION: Structured post-seclusion/post-restraint debriefings with patients constitute a possible intervention to reduce coercive measures, but as of now there is little scientific evidence for the efficacy. Incorporating them into complex therapeutic treatment concepts for ward programs appears to be meaningful.
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