Use of direct coercive measures on the example of psychiatric hospital in Wrocław
Marta Jakubczyk

Introduction and aims of the study
The prospective study was carried out in the psychiatric hospital in Wrocław because of the highest rates of coercion recorded in the Lower Silesian Voivodship.
Aims of the study are to assess: 1) the frequency of direct coercive measures in the hospital, 2) the main factors predisposing to direct coercion. 
Material and methods
Hospitalised patients and situations of use of direct coercion were assessed with the help of selected tools (MPCS, BPRS, GAF, CAT, MANSA) and additional questionnaires on basic data. The study included patients who during their stay felt a sense of coercion or were hospitalised without consent or were coerced during their hospitalisation. 346 patients were enrolled in the study, of which 237 were interviewed in person.
Results
The rate of use of direct coercion reached a value of almost 21% in relation to all patients. Mechanical restraint dominated and accounted for 80% of all episodes.
Admissions under Articles 22.2a and 24.1 of Mental Health Act were associated with a higher risk of direct coercion, and this risk decreases significantly in the case of admissions under Artcle 29. The use of direct coercion during earlier hospitalisations and multiple previous hospitalisations without consent, severity of symptoms examined using the BPRS, lower score in functioning measured using the GAF are associated with an increased risk of direct coercion.
Conclusions
The psychiatric hospital in Wroclaw is characterised by relatively higher rates of direct coercion in comparison to national surveys. There are risk factors which should be taken into consideration in case of admission to psychiatric hospital.

27th European Congress of Psychiatry