# Relative efficiency of psychiatric clinics in treating cases without coercion and achieving symptom reduction

## TL;DR

This study examines how psychiatric clinics in Switzerland can reduce coercion and improve symptom reduction through better management practices.

## Contribution

The study introduces a novel application of Data Envelopment Analysis to assess management-driven efficiency in psychiatric care.

## Key findings

- Clinics could improve coercion-free treatment by 9% and symptom reduction by up to 34% with current staff levels.
- Management factors like staff training and ward structure significantly impact efficiency in reducing coercion.
- Clinic size had no effect on efficiency scores for coercion reduction or symptom improvement.

## Abstract

The use of coercive measures is an increasingly debated aspect of psychiatric treatment. Considering the multitude of negative effects, patients, clinicians, and ethicists alike have called for a more cautious application of coercion. It therefore remains important to investigate which organizational characteristics have the potential to facilitate efficient coercion reduction. The same holds true for the efficient reduction of symptom severity during inpatient treatment.

The current study compared 22 Swiss psychiatric clinics treating 45,095 cases regarding their relative efficiency in treating cases without coercion given their staff resources. To this end, we applied a Data Envelopment Analysis to clinical routine data. We focused specifically on inefficiencies attributable to management factors independent of the clinics’ total staff numbers. We further compared the clinics’ relative efficiencies regarding changes of self-reports and third-person reports of symptom severity during inpatient stays.

Efficiency scores suggest that on average, the clinics could improve the percentage of cases treated without coercion by 9% and the changes of symptom severity by 34% (for third-person ratings) or 18% (for self-reports) while keeping staff numbers constant. An analysis of specific coercion types revealed that the potential for efficiency improvements via management was highest for movement restrictions. We found no effect of clinic size on efficiency scores regarding any of the outcome measures.

Our results underline the importance of management factors beyond staff resources (e.g., staff trainings or changes in ward structure and treatment concepts) for the efficient reduction of coercion and psychiatric symptoms during inpatient stays.