Should I go to psychiatry or to technology?

Coercive Measures in Psychiatry

The Bavarians had probably not expected so much headwind: After the Free State presented the draft for its new Mental Health Assistance Act in April 2018, there was great outrage. Professional associations, those affected and data protection activists came together to oppose the attempt to save the data of psychiatric patients in a police file for five years. According to the new law, patients would be treated like criminals, it was alleged.

This reinforces the already existing stigmata against the mentally ill. The plans have meanwhile been abandoned. But even under the current rules, patients sometimes have to reckon with violent measures: reluctance to instruct, restraint or isolation in the room, for example. But when are these restrictions on freedom even legal? And what can be done to give those affected more autonomy?

When are clinics allowed to initiate compulsory treatment?

Adults in Germany can get to a psychiatric clinic against their will in three ways. The first is anchored in criminal law. If, for example, a psychotic patient burns down a house in an acute phase and is regarded by the court as having reduced criminal liability, she can be placed in a psychiatric hospital - the so-called penal system. The second way is through the care system: A legal supervisor can initiate a briefing, but must have this approved by a judge. This option often affects chronically ill or disabled people.

However, the public law route via the so-called Mental Illness Laws is the main topic of heated discussion. There are 16 of them, one for each federal state. In order to obtain instruction about this, a patient must pose an acute risk to himself or to others. This often applies to people who want to take their own life, for example. But the legal criteria are strict, ultimately only a judge can decide whether the measure is really justified. A clinic cannot, of its own accord, impose any compulsory admission. In addition, patients can also legally defend themselves against their placement, for example by filing a complaint with the responsible regional court.

What makes accommodation so tricky?

"For us psychiatrists and psychotherapists it is a daily dilemma," says Arno Deister, President of the German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN). On the one hand there is the right to self-determination, on the other the right to physical integrity. "Sometimes you can't do both at the same time," says Deister. "The only reason for a coercive measure is to bring people as soon as possible back into a state in which they are capable of self-determination again."

Here too, however, the following applies: the measure must be proportionate. It was only in March 2018 that the Federal Court of Justice (BGH) received the decision of a regional court. A Bavarian who suffered brain damage after a traffic accident had sued. For almost eight and a half years, the person being cared for had already been accommodated, now the measure should be extended again "for an indefinite period". The BGH overturned the decision and referred the matter back to the regional court. The judges emphasized in their decision that the mentally ill should have a freedom perspective.