Deutsche Version
Background
The professional use of coercion in psychiatry (such as compulsory medication, compulsory restraint, isolation) is one of the measures that deprive everyone (patients, relatives and professional teams), albeit differently, but to a great extent.
Patients and all clinical professional groups, but sometimes also external employees of the police, courts, fire brigade or rescue service are involved in coercive measures on psychiatric acute wards. The social relevance of the topic (around 200,000 - 300,000 forced restraints per year in Germany alone in adult psychiatry) is undisputed in the scientific literature.
The extensive studies on research into dangerous situations in acute psychiatric wards suggest 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 the therapy programs begin, or at lunchtime when the teams are less available for private discussions. In such situations, patients and teams seem to challenge each other and push them to their limits. A coercive measure is ultimately a testimony that communication has failed - “a psychiatric accident”: The attempt to resolve the conflicts in dangerous situations without coercion fails.
The SRCP project explores the development 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 jeopardizing situations are comparable or distinguishable by which communication features. What is the difference between jeopardizing situations in which de-escalation is possible and those which escalate? Which rules control the interactions?
Aims of the research group
On the basis of a language and situation theory approach, the superordinated aims of our research group are:
- Reconstruction of psychiatric jeopardizing situations;
- Identification of linguistic patterns in the course of interactions with by means of locutionary and illocutionary aspects of speech acts;
- Identification of regulative and constitutive rules that control the interaction patterns;
- Identification of the communicative conditions for success (conditions for success, seriousness and truth) of utterance files in psychiatric dangerous situations;
- Systematization of the process dynamics of jeopardizing situations by means of decision trees;
- Classification and typology of jeopardizing situations;
- Development of scientifically supported alternative scenarios for the use of psychiatric coercion.
Around 60 people, mostly male and female nurses, took part in the study in one forensic and two general psychiatric acute wards in clinics of Hannover Region. The database consists of video recordings of jeopardizing situations that were re-enacted by persons concerned using the psychodrama method. The subsequent short-term analysis led to the identification of several interaction patterns, such as “negative reciprocity” or “over-demanding” (etc.). The long-term analysis shows how interaction processes can be divided into typical phases shortly before the immediate enforcement of coercive measures.
Literature:
- Radovic, M., Debus, S. 2019 Zur Kommunikationsstruktur von Gefährdungssituationen - PART II: "Simulation und Reduktion von Zwangsmaßnahmen in der Psychiatrie" (SRZP). Psych.Prax. 46(Suppl.1): S21-S28. DOI
- Debus, S., Radovic, M. 2019 Zur Kommunikationsdynamik von Gefährdungssituationen - PART III: "Simulation und Reduktion von Zwangsmaßnahmen in der Psychiatrie" (SRZP). Psych.Prax. 46(Suppl.1): S29-S37. DOI
- Ahrens, U., Haage, J., Luzycki, T., Milark, S., Debus, S. 2019 Fallstudie: Entwicklung von symbolischen Alternativen zur physischen Zwangsanwendung in Gefährdungssituationen - PART IV: "Simulation und Reduktion von Zwangsmaßnahmen in der Psychiatrie" (SRZP). Psych.Prax. 46(Suppl.1): S38-S49. DOI
Jeopardizing situations in the emergency psychiatric rescue service differ fundamentally in their complexity from clinical jeopardizing situations, i.e.: the locations of the situations (e.g. private households, street, social facilities, clinics, family physicians) as well as the composition of the rescue teams (fire brigade, police, emergency doctor, emergency medical service, social psychiatric service, paramedics) and other people involved (relatives, pedestrians, neighbours, "gawkers" etc.). In particular, in contrast to the clinic, emergency operations are controlled via a rescue control center. Interactive processes and rules for emergency operations are therefore more complex and require special methods of discourse analysis based on the theory of speech.
The research into the interactive and communicative behaviour of the actors in psychiatric jeopardizing situations requires the development of innovative methods for the sequential language analysis of the 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 with its precise definitions of speech behaviour useful for empirical language research and reliability studies. New challenges exist in the application of situation semantic concepts.
Literature:
- Debus, S. 2019 Mixed-Methods-Design zur Analyse von Gefährdungssituationen mittels Kommunikationsprofilen - PART I: "Simulation und Reduktion von Zwangsmaßnahmen in der Psychiatrie" (SRZP). Psychiatrische Praxis 46(Suppl.1): S11-S20. DOI
- Debus, S. 2019 Ein Kommunikationsmodell zur Durchsetzungsmacht in psychiatrischen Gefährdungssituationen - PART V: "Simulation und Reduktion von Zwangsmaßnahmen in der Psychiatrie" (SRZP). Psych.Prax. 46(Suppl.1): S50-S59. DOI
- Posner, R., Debus, S. 2011 Semiotische Milieuforschung in der Sozialwissenschaft. Tübingen: Stauffenburg Verlag., see here
Scientific collaborations
Germany-wide:
- Klinikum Region Hannover, Psychiatrie Langenhagen
- Klinikum Region Hannover, Forensische Psychiatrie, Wunstorf
- Sozialpsychiatrische Kontaktstelle Hannover
- Psychodramaforum, Berlin
- Technische Universität Berlin, Arbeitsstelle für Semiotik
- Helmut-Schmidt-Universität, Hamburg, Fächergruppe Mathematik, Statistik
- Fachhochschule Hannover, Fakultät V, Abt. Soziale Arbeit
- Fernuniversität Hagen, Fakultät für Kultur- und Sozialwissenschaften
International:
- Alpen-Adria-Universität Klagenfurt, Fakultät für Kulturwissenschaften, Österreich
Equipment
The SRCP 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 the preparation of doctorates, master's and bachelor's theses:
Participative Internet Portal Psychiatry (PIPP): https://www.pipp.pro.
Research group members
Research group leader
PD Dr. Stephan Debus
University lecturer, SRCP project manager
Phone: +49 5103 7067743
Fax: +49 5103 7045892
Publications [PMID]: 9816602, 30743302, 30743305, 30743306, 30743307
Other positions:
- Member of the task force “Research”, German. German society of Social Psychiatry (Deutsche Gesellschaft für Soziale Psychiatrie [DGSP])
- Speaker of the task force: "Network: Psychiatry Without Violence" (DGSP)
- Member of the advisory board of the German Society for Semiotics (DGS)
- Head of the Institute for Cultural Semiotics, Wennigsen
- Long-time editor of the magazine for semiotics (Magazine for Semiotic)
Phone: +49 5103 7067743
Fax: +49 5103 7045892
Doctoral thesis / Research focus: Simulation and reduction of coercive measures - the communication structure of dangerous situations
Publications: PMID30743303, PMID30743304
Phone: +49 5103 7067743
Fax: +49 5103 7045892
Doctoral thesis / Research focus: Simulation und reduction of coercive measures in psychiatry: conflict and prevention research in emergency rescue services
Phone: +49 5103 7067743
Fax: +49 5103 7045892
Co-founder and long-time editor of the 'Zeitschrift für Semiotik' ('Journal of Semiotics')
Publication: PMID30743307
Phone: +49 511 813993
Fax: +49 5103 7045892
Coach / trainer for Psychodrama (Psychodramaforum Berlin)
Publication: PMID30743305
Phone: +49 5103 7067743
Fax: +49 5103 7045892
Master thesis: official title: 'Simulation und Reduktion von Zwangsmaßnahmen in der Psychiatrie (SRZP) – Sprechaktanalyse der Kommunikation von Krankenpflegenden in psychiatrischen Gefahrensituationen'
engl. translation: 'Simulation and reduction of coercive measures in psychiatry (SRZP) - speech act analysis of nurses' communication in dangerous situations in psychiatry'
Further positions: long-term nursing manager of an acute psychiatric ward
Publication: PMID30743305
Phone: +49 5103 7067743
Fax: 05103 7045892
Bachelor thesis: official title: 'Simulation und Reduktion von Zwangsmaßnahmen in der Psychiatrie – Wie verlaufen Gefahrensituationen in der Psychiatrie ab und wie können sie deeskaliert werden? Prozessanalyse von Simulationen mithilfe des Psychodramas'
engl. translation: 'Simulation and reduction of coercive measures in psychiatry - How do dangerous situations unfold in psychiatry and how can they be de-escalated? Process analysis of simulations with the help of psychodrama'