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BMC Psychiatry Taylor, Tatiana L. Killaspy, Helen Wright, Christine Turton, Penny White, Sarah Kallert, Thomas W. Schuster, Mirjam Cervilla, Jorge A. Brangier, Paulette Raboch, Jiri Kalisova, Lucie Onchev, Georgi Dimitrov, Hristo Mezzina, Roberto Wolf, Kinou Wiersma, Durk Visser, Ellen Kiejna, Andrzej Piotrowski, Patryk Ploumpidis, Dimitri Gonidakis, Fragiskos Caldas-de-Almeida, Jose Cardoso, Graca King, Michael B.European Commission The authors would like to acknowledge all members of the international DEMoBinc Research Group and the project's funder, the European Commission. 138 BIOMED CENTRAL LTD LONDON 505SH Background: A proportion of people with mental health problems require longer term care in a psychiatric or social care institution. However, there are no internationally agreed quality standards for institutional care and no method to assess common care standards across countries. We aimed to identify the key components of institutional care for people with longer term mental health problems and the effectiveness of these components. Methods: We undertook a systematic review of the literature using comprehensive search terms in 11 electronic databases and identified 12,182 titles. We viewed 550 abstracts, reviewed 223 papers and included 110 of these. A "critical interpretative synthesis" of the evidence was used to identify domains of institutional care that are key to service users' recovery. Results: We identified eight domains of institutional care that were key to service users' recovery: living conditions; interventions for schizophrenia; physical health; restraint and seclusion; staff training and support; therapeutic relationship; autonomy and service user involvement; and clinical governance. Evidence was strongest for specific interventions for the treatment of schizophrenia (family psychoeducation, cognitive behavioural therapy (CBT) and vocational rehabilitation). Conclusion: Institutions should, ideally, be community based, operate a flexible regime, maintain a low density of residents and maximise residents' privacy. For service users with a diagnosis of schizophrenia, specific interventions (CBT, family interventions involving psychoeducation, and supported employment) should be provided through integrated programmes. Restraint and seclusion should be avoided wherever possible and staff should have adequate training in de-escalation techniques. Regular staff supervision should be provided and this should support service user involvement in decision making and positive therapeutic relationships between staff and service users. There should be clear lines of clinical governance that ensure adherence to evidence-based guidelines and attention should be paid to service users' physical health through regular screening. publishersversion published

Background Despite the recent increase of research interest in involuntary treatment and the use of coercive measures, gender differences among coerced schizophrenia patients still remain understudied. It is well recognized that there are gender differences both in biological correlates and clinical presentations in schizophrenia, which is one of the most common diagnoses among patients who are treated against their will. The extent to which these differences may result in a difference in the use of coercive measures for men and women during the acute phase of the disease has not been studied. Methods 291 male and 231 female coerced patients with schizophrenia were included in this study, which utilized data gathered by the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) and was carried out as a multi-centre prospective cohort study at 13 centers in 12 European countries. Sociodemographic and clinical characteristics, social functioning and aggressive behavior in patients who received any form of coercive measure (seclusion and/or forced medication and/or physical restraint) during their hospital stay were assessed. Results When compared to the non-coerced inpatient population, there was no difference in sociodemographic or clinical characteristics across either gender. However coerced female patients did show a worse social functioning than their coerced male counterparts, a finding which contrasts with the non-coerced inpatient population. Moreover, patterns of aggressive behavior were different between men and women, such that women exhibited aggressive behavior more frequently, but men committed severe aggressive acts more frequently. Staff used forced medication in women more frequently and physical restraint and seclusion more frequently with men. Conclusions Results of this study point towards a higher threshold of aggressive behavior the treatment of women with coercive measures. This may be because less serious aggressive actions trigger the application of coercive measures in men. Moreover coerced women showed diminished social functioning, and more importantly more severe symptoms from the “excitement/hostile” cluster in contrast to coerced men. National and international recommendation on coercive treatment practices should include appropriate consideration of the evidence of gender differences in clinical presentation and aggressive behaviors found in inpatient populations.

Background The Czech Republic took part in the international EUNOMIA project, which pursued the application of coercive measures in psychiatric treatment. 5 – 35% of the patients with acute mental disorder are involuntarily admitted to psychiatric facilities in the Czech Republic. Previous reports showed that the majority of the patients in the Czech Republic feels to be admitted under duress of their family members, physicians and also the police. The subjective perception of the coercion is undoubtedly connected with an insufficient insight resulting from their illness. The aim of this presentation was to find out, in the group of involuntarily admitted patients, in which manner follow-up care proceeds after their release from the hospital, and to monitor, if any general pressure to adhere to the treatment exists.