Patient awareness of viral hepatitis infection in Al-Madinah, Saudi Arabia: a cross-sectional study.

The use and benefit of coercive measures in psychiatry, including forced medication, seclusion and physical restraint, remain the subject of considerable debate in both the scientific literature and clinical practice [–]. The controversy is reinforced by findings showing that the use of coercive measures is often determined by ideological decisions and varies significantly across countries in the European Union [, ]. On the one hand, coercive measures should be applied to protect individuals in emergency situations in which they pose a danger to themselves and/ or others []. On the other hand, such measures restrict the personal freedom of the individual concerned and conflict with core ethical principals in psychiatry, such as patient autonomy [, ]. Furthermore, evidence suggests that coercive measures are frequently applied without direct benefit to the individual concerned [, ]. Such measures may result in substantial adverse outcomes for both patients and clinical staff, manifesting in negative short- and long-term consequences (e.g. post-traumatic stress symptoms) []. In addition, the majority of patients perceive coercive measures as humiliating and punitive (for an overview see 1). Therefore, it is essential to reduce the use of coercive measures to an absolute minimum and apply them only as a last resort [, , ]. Against this background, the present study investigates whether the implementation of a psychotherapeutic framework within routine psychiatric care can contribute to reducing the use and duration of coercive measures. One effective way to reduce the use of coercive measures is to train psychiatric staff to deescalate dangerous situations before coercion becomes unavoidable []. Therapeutic interventions such as validation and commitment strategies can be helpful in these situations, as they strengthen staff members’ sense of self-efficacy and convey to the patient that the staff understands and is able to help them. Two prominent examples of evidence-informed conflict reduction strategies are the [, ] and the [, ]. Evidence supporting these team-based interventions comes from several studies demonstrating that efforts to train psychiatric teams in negotiation and de-escalation skills are effective and worthwhile [, ]. Moreover, there is evidence that single interventions (e.g., team-reflection on previously implemented coercive measures) can reduce the number of coercive measures in psychiatry, especially when these interventions are individualized and tailored to the needs of the specific ward []. Such single (vs. complex) interventions can be more easily implemented in psychiatric care, as time constraints and patients with high care needs often limit the resources available for new initiatives. A comprehensive collection of both single and complex interventions has been provided by the German Society for Psychiatry, Psychotherapy, and Psychosomatics. They developed the clinical practice guidelines [], which comprise 89 recommendations and statements based on evidence and expert-consensus []. Initial evidence for the feasibility and effectiveness of these clinical practice guidelines has been provided by a randomized controlled trial [].