Restraints increasingly used on psychiatric patients in Switzerland

Five-points fixation on a bed in a cell in the high-security wing of the Clinic for Forensic Psychiatry at the Psychiatric Center Rheinau in the canton of Zurich (2009). © Keystone / Gaetan Bally

Patients with psychiatric disorders are increasingly subjected to restrictive measures in Swiss hospitals, according to a Tages-Anzeiger report. Experts and judicial authorities view the trend with concern.

Committing  patients against their will, tying them to their bed, isolating them in a room and administering forced medication are methods that have become relatively common at psychiatric clinics in Switzerland, according to the Swiss-German language newspaper.

The proportion of cases in which at least one restraint measure was applied reached 11.5% in 2021, compared with 9.4% in 2019, the newspaper reported, citing a study by the National Association for Quality Development in Hospitals and Clinics (ANQ). In an international comparison, Switzerland leads the way in forced hospitalisations.

Last resort

Samia Hurst, a physician and ethicist at the Geneva University Hospital (HUG), believes such methods should remain the exception. That’s because measures limiting freedom of movement are a transgression of an important right.

“They can only be justified as a last resort to protect an overriding interest, such as the protection of the patient himself or of third parties in case of dangerous behaviour,” she says. “The weighing of risks and benefits must therefore be careful. The risks are not only physical, but also identity-related: these acts can be experienced as humiliating or as a punishment.

Professionals explain the increase in these extreme acts largely by a shortage of psychiatric care staff.

“Implementing these measures in a safe way requires supervision. Their use due to a lack of personnel is therefore actually worrying,” notes Hurst, calling for data on how patients are monitored.

The subject also worries political authorities. In mid-December, the Federal Office of Justice (FOJ) published a report on forced placements. The report recommended several clarifications, especially on a patient’s possibilities for self-determination.