Background
The professional use of coercion in psychiatry (such as forced medication, forced restraint, isolation) is one of the measures that deprive people of their liberty and place a great deal of strain on all those involved (patients, relatives and professional teams), albeit to varying degrees. Coercive measures on acute psychiatric wards involve patients and all clinical professional groups, but sometimes also external staff from the police, courts, fire department or ambulance service. The social relevance of the topic (around 200,000 - 300,000 restraints per year in Germany in adult psychiatry alone) is undisputed in the scientific literature.
The extensive research on dangerous situations in acute psychiatric wards suggests that violence and coercion only occur more frequently in certain situations, at certain times and in certain places, e.g. in front of duty rooms or closed ward doors, often on Monday mornings when therapy programs begin, or at lunchtime when the teams are less available for discussions. In such situations, patients and teams seem to challenge each other and push each other to their limits. A coercive measure is ultimately a testimony to the fact that Communications fails - "a psychiatric accident": the attempt to resolve conflicts in dangerous situations without coercion fails.
The LRCP project investigates the emergence and course of violence and coercion in psychiatric dangerous situations. The central question is: what happens between the actors in psychiatric dangerous situations in which coercion and violence either escalate or de-escalate? Which dangerous situations can be compared or distinguished by which communication characteristics? What distinguishes dangerous situations in which de-escalation is possible from those that escalate? What rules govern the interactions?
Overarching goals
Based on a linguistic and situation-theoretical approach, the overarching aims of our research group are to...
- Reconstruction of psychiatric risk situations
- Identification of linguistic patterns in the course of interactions with the help of locutionary and illocutionary aspects of speech acts
- Identification of regulative and constitutive rules that control interaction patterns
- Identification of the communicative conditions for success (conditions of success, seriousness and truthfulness) of utterance acts in psychiatric endangerment situations
- Systematization of the process dynamics of dangerous situations with the help of decision trees;
- Classification and typology of dangerous situations
- Development of scientifically supported alternative scenarios for the use of psychiatric coercion
Around 60 people, mostly nurses, took part in the study in one forensic and two general psychiatric acute wards in Clinical Departments in the Hanover region. The data basis consists of video recordings of dangerous situations that were restaged by the participants using the psychodrama method. The subsequent short-term analysis led to the identification of several interaction patterns, such as "negative reciprocity" or "over-demanding". The long-term analysis shows how interaction processes can be divided into typical phases shortly before the immediate use of coercion.
Publications:
- Radovic, M., Debus, S. 2019 On the communication structure of dangerous situations - PART II: "Simulation and reduction of coercive measures in psychiatry" (SRZP). Psych.Prax. 46(Suppl.1): S21-S28.
- Debus, S., Radovic, M. 2019 On the communication dynamics of dangerous situations - PART III: "Simulation and reduction of coercive measures in psychiatry" (SRZP). Psych.Prax. 46(Suppl.1): S29-S37.
- Ahrens, U., Haage, J., Luzycki, T., Milark, S., Debus, S. 2019 Case study: Development of symbolic alternatives to the physical use of coercion in dangerous situations - PART IV: "Simulation and reduction of coercive measures in psychiatry" (SRZP). Psych.Prax. 46(Suppl.1): S38-S49.
Psychiatric risk situations in emergency psychiatric rescue services differ fundamentally in their complexity from clinical risk situations. Both the locations of the situations (e.g. private households, streets, social institutions, Clinical Departments, general practitioners) and the composition of the rescue teams (fire department, police, emergency physician, emergency medical service, social psychiatric service, paramedics) and other persons involved (relatives, street passers-by, neighboring residents, "gawkers", etc.) vary. In contrast to the Clinical Department, emergency operations are controlled via a rescue control center. The interactive processes and rules of emergency operations are therefore more complex and require special methods of discourse analysis based on speech act theory.
Research into the interactive and communicative behavior of actors in psychiatric risk situations requires the development of innovative methods for sequential language analysis of video material. The theoretical background is provided by semiotics with its sub-disciplines: semantics, syntactics and pragmatics. In our research project, we have made speech act analysis in particular, with its precise definitions of speech behavior, usable for empirical language research and for reliability studies. New challenges exist in the application of situation-semantic concepts.
Publications:
- Debus, S. 2019 Mixed-methods design for the analysis of dangerous situations using communication profiles - PART I: "Simulation and reduction of coercive measures in psychiatry" (SRZP). Psychiatric Practice 46(Suppl.1): S11-S20.
- Debus, S. 2019 A communication model for assertive power in psychiatric endangerment situations - PART V: "Simulation and reduction of coercive measures in psychiatry" (SRZP). Psych.Prax. 46(Suppl.1): S50-S59.
- Posner, R., Debus, S. 2011 Semiotic milieu research in the social sciences. Tübingen: Stauffenburg Verlag.
Scientific collaborations
External (Germany-wide):
- Klinikum Region Hannover, Psychiatry Langenhagen
- Hannover Region Clinic, Forensic Psychiatry, Wunstorf
- Hanover Social Psychiatric Contact Center
- Psychodrama Forum, Berlin
- Technical University of Berlin, Center for Semiotics
- Helmut Schmidt University, Hamburg, Department of Mathematics, Statistics
- Hanover University of Applied Sciences and Arts, Faculty V, Department of Social Work
- University of Hagen, Faculty of Cultural and Social Sciences
External (international):
- Alpen-Adria-Universität Klagenfurt, Faculty of Cultural Studies, Austria
Equipment
The SRZP project cooperates with the Institute for Cultural Semiotics. The Institute provides a seminar hall that functions as a "social lab" and is specially equipped for video recordings. The "social lab" is networked with a video production studio. The videos are made available via an inter-university internet platform for analysis by students from colleges and universities as part of their doctoral, Master's and Bachelor's theses:
Participatory Internet Portal Psychiatry (PIPP): https://www.pipp.pro.
Research group members
Head of research group
PD Dr. Stephan Debus
University lecturer, SRZP project leader
Phone: +49 05103 7067743
Fax: -49 5103 7045892
Publications [PMID]: 9816602, 30743302, 30743305, 30743306, 30743307
Other positions:
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Member of FA Research, Deutsch. Gesell. Soc. Psychiatry (DGSP)
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Spokesperson of the FA "Network: Psychiatry without Violence" (DGSP)
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Member of the advisory board of the German Society for Semiotics (DGS)
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Head of the Institute for Cultural Semiotics, Wennigsen;
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Editor of the Journal for Semiotics for many years.
Telephone: +49 5103 7067743
Fax: +49 5103 7045892
Doctoral thesis / research focus: Simulation and reduction of coercive measures - on the communication structure of dangerous situations.
Publications: PMID30743303, PMID30743304
Telephone: +49 5103 7067743
Fax: +49 5103 7045892
Doctoral thesis / research focus: Simulation and reduction of coercive measures in psychiatry: conflict and prevention research in emergency services.
Telephone: +49 5103 7067743
Fax: +49 5103 7045892
Other position: Co-founder and long-standing editor of the Journal of Semiotics
Publications: PMID30743307
Telephone: +49 511 813993
Fax: +49 5103 7045892
Other position: Psychodrama trainer (Psychodramaforum Berlin)
Publications: PMID30743305
Telephone: +49 5103 7067743
Fax: +49 5103 7045892
Master's thesis: Simulation and reduction of coercive measures in psychiatry (SRZP) - speech act analysis of nurses' communications in psychiatric dangerous situations
Other position: Long-term nursing manager of an acute psychiatric ward
Publication: PMID30743305
Telephone: +49 5103 7067743
Fax: +49 5103 7045892
Bachelor's thesis: Simulation and reduction of coercive measures in psychiatry - How do dangerous situations in psychiatry unfold and how can they be de-escalated? Process analysis of simulations with the help of psychodrama