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Objective: Examination of gender-related differences of aggressive incidents and the use coercive measures within a whole psychiatric hospital with a catchment area of 339.000 inhabitants over a period of fifteen years., Methods: Recording of aggressive incidents using the Staff Observation Aggression Scale-Revised (SOAS-R) as well as coercive measures by a clinically developed record sheet and analysing gender-related differences from 2005 to 2019., Results: 82 833 inpatients (male: 55.3 %; female: 44.7 %) are included. Between 2005 and 2019, 60.1 % of the aggressive events involved male patients and 39.9 % involved female patients; however, regarding cases of treatment no gender-related difference existed (odds ratio: 1.1). The SOAS-R-severity score of women was significantly higher, while aggressive incidents of men were subjectively graded more serious by staff. The number of coercive measures and the mean duration of restraint and seclusion episodes were significantly higher and longer, respectively, in male inpatients., Conclusion: Differences in frequency and duration of coercive measures between male and female patients could be influenced by the subjective perception of staff that male patients behave more aggressively., Competing Interests: Die Autorinnen/Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

OBJECTIVE Since 1996 three, meanwhile eight, psychiatric hospitals have been working closely together in a multidisciplinary team aiming at improving quality management and reducing the frequency and duration of coercive measures, respectively. METHODS Development, aims, and functioning of the cooperation are described, and selected data of comparisons of documented restraints and of coercive measures in one of the hospitals (1998-2004) are presented. RESULTS This way of cooperation was conductive to changes in organizational policies and practices of coercive measures and, in parts, resulted in reducing coercive measures. CONCLUSIONS The cooperation was effective in improving quality management and implementation of changes in practice of coercive measures.

Since 1996 three psychiatric hospitals have been working together closely in a team aiming at improving the quality management of coercive measures. The first comparison of documented restraints showed conspicuous differences in incidence and duration. Due to this, the group decided to document and to compare the incidence, duration and reason of restraints and the legal status and sociodemographic variables in the three hospitals over one year. Considerable deviations were found with regard to the number and duration of restraints and number of patients concerned. Hospital A (2622 admissions) registered 103 restraints of 53 persons whereas hospital B (5802 admissions) reported 254 restraints of 121 persons, hospital C (4252 admissions) finally, documented 621 restraints of 120 persons. Hypotheses giving reason for these findings are discussed. Furthermore, developments and changes aiming at reducing coercive measures and at complete and comparative documentation by co-operation of the three hospitals, are reported.