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Neugestaltung einer Akutpsychiatrie – ein Werkstattbericht

  • Daniel SchöttleEmail author
  • Jürgen Gallinat
Originalarbeit
  • 20 Downloads

Zusammenfassung

Zwangsmaßnahmen sind trotz der Bemühungen um deren Vermeidung Teil des Alltags auf psychiatrischen Akutstationen. Diese werden durch verschiedene Faktoren begünstigt, die den vor-, den stationären und poststationären Bereich betreffen. Es werden in diesem Artikel, basierend auf der klinischen Erfahrung auf unserer Akutstation, Lösungsansätze vorgeschlagen und diskutiert, die dazu beitragen können, Zwangsmaßnahmen zu reduzieren. Diese umfassen neben baulichen Maßnahmen u. a. die Implementierung von sektorenübergreifenden, niedrigschwelligen, bedürfnisorientierten und flexibel angepassten Behandlungssystemen (z. B. Integrierte Versorgung (IV), Stationsäquivalente Behandlung [STÄB]), ausreichend verfügbares Personal, in komplexen, deeskalierenden Kommunikations- und Interaktionsstrategien geschulte Mitarbeiter, die ein breit angelegtes therapeutisches Gesamtkonzept umsetzen, Genesungsbegleiter, Nachbesprechungen, Behandlungsvereinbarungen und eine enge Vernetzung innerhalb und außerhalb der Klinik mit verschiedenen Leistungsanbietern. Hinzu kommt die kritische Auseinandersetzung mit den Behörden und der Politik über die oft unzureichenden Möglichkeiten, Patienten in offene oder geschützte Wohneinrichtungen wohnortnah weitervermitteln zu können.

Auch wenn sich Zwangsmaßnahmen nicht gänzlich vermeiden lassen, so bedarf es einer kritischen und verantwortungsvollen Auseinandersetzung in Einsatz und Umgang mit diesen sowie längerfristiger therapeutischer ambulanter und stationärer eng verzahnter Konzepte. Diese setzen einen ausreichenden Personalschlüssel und die Aufhebung der Sektorengrenzen voraus. Entscheidend für den Erfolg dieser Maßnahmen ist zudem die Haltung der therapeutischen Teams.

Schlüsselwörter

Stationäre Psychiatrie Zwangsmaßnahmen Reduktion von Zwang Therapiekonzept Deeskalierende Interaktion 

Reorganization of acute psychiatry—a workshop report

Abstract

Coercive interventions are part of the clinical work on psychiatric acute wards, despite efforts to avoid them. Their use is influenced by different factors in the preclinical, outpatient and inpatient sectors. In this article, based on clinical experiences in an acute inpatient unit approaches are suggested and discussed, which can contribute to reduce coercion in psychiatry. These include apart from improved hospital architecture, the implementation of integrated, cross-sectoral, low-threshold, flexible and individually adapted treatment systems (such as integrated care and crisis intervention teams), a sufficient number of personnel trained in complex de-escalating communication and interaction strategies that provide a broad therapeutic concept, peer workers, debriefing measures, joint crisis plans and close cooperation with stakeholders inside and outside the hospital. Furthermore, it is important to critically discuss the insufficient facilities to place patients in open or closed sheltered accommodation with healthcare authorities. Although coercive measures cannot be totally avoided, a critical and responsible debate about their use and handling is necessary, as well as long-term integrated therapeutic inpatient and outpatient care systems. These require appropriate allocation of staff and continuous treatment across different healthcare sectors. Moreover, if measures to reduce coercion are to be successful, the attitude of the therapeutic team is crucial.

Keywords

Inpatient psychiatry Coercive measures Coercion reduction Therapy concept De-escalating interaction 

Notes

Interessenkonflikt

D. Schöttle und J. Gallinat geben an, dass kein Interessenkonflikt besteht.

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Copyright information

© Springer-Verlag GmbH Deutschland, ein Teil von Springer Nature 2019

Authors and Affiliations

  1. 1.Klinik und Poliklinik für Psychiatrie und Psychotherapie, Zentrum für Psychosoziale MedizinUniversitätsklinikum Hamburg-EppendorfHamburgDeutschland

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