Implementing modular competence-oriented psychotherapy in inpatient psychiatry: a three-year analysis of restraint and seclusion.

BACKGROUND

Coercive measures remain used in psychiatric care, despite ongoing ethical concerns and efforts to minimize their application. Psychotherapeutic or competence-oriented frameworks may contribute to reducing situations that lead to coercion, yet empirical evidence is scarce.

OBJECTIVE

This naturalistic study examined whether the introduction of Modular Competence-Oriented Psychotherapy (MCP) at site A was associated with changes in the frequency and duration of coercive measures (2022-2024), compared to site B providing treatment as usual.

METHODS

Routinely collected inpatient data from two psychiatric sites in Germany were analyzed retrospectively (n = 15,361 cases). Generalized linear models assessed annual changes in the use of restraint and seclusion. Linear models examined changes in the duration of restraint and seclusion episodes.

RESULTS

Overall, the probability of coercive measures was significantly higher at site B than at site (A). At site A, the likelihood and duration of restraint and the duration of seclusion significantly declined over time, while the likelihood of seclusion remained stable. Except for seclusion duration, time trends did not differ significantly between sites. For seclusion duration, site A showed a significantly stronger decline than site (B). Descriptively, assaults decreased at site A but remained stable at site B.

CONCLUSIONS

Implementation of MCP at site A was associated with reductions in the duration of restraint and seclusion, without indications of increased risk events. Although the naturalistic design and concurrent changes at site B preclude causal conclusions, the findings offer preliminary evidence for the feasibility and potential value of integrating a competence-oriented psychotherapeutic framework in psychiatry.

CLINICAL TRIAL NUMBER: Not applicable.