Abolition of coercion in psychiatry on the horizon? A descriptive ecologic data study from six European countries.

Objective: In the last decade, UN bodies and the WHO call for the abolition of coercion in psychiatry. Studies provide some evidence for interventions to reduce the use of coercion, but it is unclear whether the use of coercion is decreasing in real-world practice. The aim of this study was to gather longitudinal ecologic data on the use of coercive interventions in European countries and to depict trends over time. Methods: For each country, inclusion required access to ecologic datasets spanning a minimum of four years, pertain to a defined population (country or federal state level), and allowing the necessary elements to calculate both the proportion of psychiatric admissions affected by involuntary admissions (IA) and coercive measures (CM) and the rate per 100,000 inhabitants. Country experts were accessed via a European network of experts (FOSTREN group). Results: Data was obtained from Austria, England, Germany, Norway, Sweden, and Switzerland, and covered periods between 4 and 10 years. In no country, an absolute decrease in IA and the use of CM could be observed. Rates of IA per 100.000 inhabitants changed between -5,4% (Sweden) and + 37% (Germany). Rates of admissions exposed to any kind of CM changed between +11% (Austria) and + 86% (Norway). Discussion: The findings suggest a persistence or rise in coercive practices despite national and international policy commitments. Increase of involuntary admissions suggests reasons outside psychiatric hospitals, whereas a disproportionate increase of coercive measures may indicate a change of practice in in-patient psychiatry. Further research is needed to explore the reasons from clinical and societal perspectives.