Measures Involving Coercive Detention and Commitment in Child and Adolescent Psychiatry in Light of the Amended § 1631b of the German Civil Code (BGB)

Abstract: Objective: The 2017 amendment to § 1631b of the German Civil Code (BGB) reformed the legal framework regarding coercive measures, distinguishing them from involuntary hospitalizations in children and adolescents. In response, the Intensive Therapy Unit of the Würzburg Department of Child and Adolescent Psychiatry underwent a comprehensive restructuring. This study examines the effects of this conceptual restructuring on closed inpatient care, with particular focus on length of stay. It also presents data on coercive measures documented since 2020. Methods: This retrospective study compares the involuntary commitment of all patients before (2012 – 2016) and after the amendment (10/2016 – 2025) and evaluates coercive measures documented since 2020. Results: Length of involuntary hospitalization decreased (median 7 vs. 1 day), while 43.9 % more patients per year were treated ( n = 189 vs. n = 272). F3 and F9 diagnoses decreased (–7.3 %, –17.8 %), while F4 and F6 diagnoses increased (+8.6 %, +8.2 %). On average, 7.8 % of cases involved at least one coercive measure, with marked differences by setting: Mechanical restraint predominated on the Intensive Therapy Unit (48.0 %), while physical holding predominated on open wards (65.5 %). Diagnoses of developmental disorders, intellectual disability, and personality disorders (OR 2.0 – 2.39) were associated with coercive measures. Conclusions: A substantial reduction in length of stay in the closed setting accompanied the conceptual restructuring. As it is difficult to clearly disentangle societal trends and the effects of the restructuring, these findings should be interpreted with caution. However, this evaluation of coercive measures provides metrics rarely reported in Germany.