Project number : 232011
Created by: Lars Kjellin, 2017-10-11
Last revised by: Lars Kjellin, 2017-10-11
Project created in: FoU Region Örebro län



  1. EUNOMIA-projektet, PUL-anmälan
  2. EUNOMIA-projektet, Projektbeskrivning

Titel och sammanfattning

Populärvetenskaplig sammanfattning

Psykiatrin i Örebro län deltar som enda psykiatrisk verksamhet i Skandinavien i det EU-finansierade forskningsprojektet EUNOMIA (European evaluation of of Coercion in Psychiatry and Harmonisation of Best Clinical Practise). Bakgrunden till studien är att psykiatrisk tvångsvård varierar kraftigt mellan europeiska länder med avseende på frekvens, innehåll och lagreglering. Gemensamma europeiska riktlinjer på området saknas. I projektet ingår tretton europeiska regioner i tolv länder (Bulgarien, England, Grekland, Litauen, Israel, Italien, Polen, Slovakien, Spanien, Sverige, Tjeckien och Tyskland). Från Sverige medverkade de psykiatriska klinikerna i Hallsberg, Karlskoga, Lindesberg och Örebro samt Karlakliniken och Beroendecentrum. Genom strukturerade intervjuer med patienter och anhöriga samt från klinisk dokumentation samlades uppgifter om tvångsintagningar, tvångsåtgärder, faktorer som påverkar dessa och resultat av behandlingen. Datainsamlingen avslutades 2006. Resultaten från studien utgör bland annat underlag för  förslag till europeiska riktlinjer om ”best clinical practise” när det gäller tvångsvård inom psykiatrin. Projektet koordineras från Dresden i Tyskland.

Sammanfattning på engelska

Coercive psychiatric treatment (involuntary admission, seclusion, restraint and
medication) varies widely between European countries with regard to its frequency,
type and legal background. These variations are often difficult to explain, which
raises the question whether coercive psychiatric treatment might entail unnecessary
infringements of patients' rights or might not be therapeutically optimal. Therefore,
the goal of the study is to analyse existing variation in coercive psychiatric treatment
in 12 European regions in 12 countries, using a naturalistic approach. Data on
coercive measures, their influencing factors and out- comes, will be gathered with
structured and validated instruments. By integrating this transnational data base with
knowledge from legal experts, ethical experts and user organisations, national and
European guidelines on best clinical practise of coercive treatment in psychiatry will
be drawn up and widely disseminated.
Coercive psychiatric treatment measures, their influencing factors and outcomes, will
be described using structured assessment instruments. This will be done in 12
comparably sized regions in 12 European countries (Bulgaria, Czech Republic,
Germany, Greece, Spain, Italy, Israel, Lithuania, Poland, Slovakia, Sweden, United
Kingdom). Central assessment tool is a computerised documentation system,
specially designed for describing coercive treatment measures, patients' sociodemographic
data and clinical variables. Complementing it with further
questionnaires and interviews, in each centre, at four points in time, two groups of
patients will be assessed: legally involuntary admissions and legally voluntary
admissions. Prerequisites for this approach are the translation of all instruments into
all national languages and their validation (where necessary), researcher training and
structured description of the catchment areas. The thus established database will be
integrated with expert reports into guidelines on best clinical practice, and widely
Description of work:
During the project's 9-month preparation and piloting phase, work will begin with the
constitution of a steering group, the setting up of reliable communication links
between all partners and the implementation of a project-specific web site. Approval
on ethical and data protection issues will be obtained in each centre. Special working
groups on legal issues and policy counselling will be formed. These will draw up
dissemination strategies and provide continuous expert advice.
Further tasks are the planning and implementation of a computerised documentation
system, the translation and validation of assessment instruments, the development
and piloting of open interviews and the training of researchers and staff in using
these assessment instruments in order to reach high inter-rater and intra-rater
reliability. The preparation and piloting phase will be concluded with a 3-month
piloting of all assessment instruments in clinical routine.
During a 21-month data gathering phase, the assessment procedure set up during
the previous months will be continued, data on part of the variables will be entered
into the computerised documentation system, the remaining data will be collected in
a separate study-specific data base. At regular time intervals, these data will be
transferred to the co-ordinating centre.
In a 6-month analysis and dissemination phase, statistical analyses will be
performed. Local focus groups and a European workshop will be integrating the
study's findings with knowledge from legal and ethical experts as well as from user
organisations into guidelines for best clinical practise of coercive psychiatric
The project will be concluded by handing over the documentation system into
national responsibility, disseminating the findings at conferences, through journals,
and through brochures aimed at specific groups. Dissemination will be directed at all
professional groups involved in the process of involuntary admission and at user
Milestones and expected results:
Crucial milestones and results are translated and validated assessment instruments,
a computerised documentation system, structured descriptions of catchment areas,
statistical models on coercive treatment, ethical and legal expert reports, 12 national
and 1 European guideline on best clinical practise of coercive psychiatric treatment.
These will be widely disseminated, aiming at improving of public health reports,
strengthening user involvement and influencing political and legal decisions.

Projektspecifik information


checked Psykiatri

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Randomiserad studie


Diagnoskod för huvuddiagnos

F20-F29 Schizofreni, schizotypa störningar och vanföreställningssyndrom



Planerat startdatum


Planerat slutdatum


Studiens status

Projektet avslutat

Vetenskaplig sammanfattning


Coercive psychiatric treatment (forced admission, involuntary detention, seclusion, restraint and forced medication) varies widely between European countries with regard to its frequency, type and legal background. These variations are often difficult to explain, which raises the question whether coercive psychiatric admission and treatment might (a) entail unnecessary infringements of patients' rights and (b) have therapeutically negative effects.


The existing variation in coercive psychiatric treatment is being analysed, using a naturalistic approach. This is being done in 12 European regions of comparable size. Data on coercive measures, their influencing factors and outcomes of the index treatment are being gathered in structured interviews with patients and from clinical documentation. By integrating this trans-national database with knowledge from legal experts, ethical experts, users’ and relatives' organisations, national and European guidelines on best clinical practise of coercive treatment in psychiatry will be drawn up and widely disseminated, aiming at improving public health reports and strengthening user involvement.

Participating centres

§ Department of Psychiatry and Psychotherapy, Dresden Technical

University, Dresden, Germany

§ Department of Psychiatry, Medical University of Sofia, Bulgaria

§ Department of Psychiatry, 1st Medical School of Charles University,

Prague, Czech Republic

§ Psychiatric Hospital of Thessaloniki, Thessaloniki, Greece

§ School of Social Work, Tel Aviv University, Tel Aviv, Israel

§ Department of Psychiatry, Second University of Naples, Italy

§ Clinic of Psychiatry, Vilnius University, Vilnius, Lithuania

§ Department of Psychiatry, Wrocław Medical University, Wrocław, Poland

§ Psychiatric Hospital of Michalovce, Michalovce, Slovakia

§ Department of Legal Medicine and Psychiatry, University of Granada,


§ Unit for Social and Community Psychiatry, Newham Centre for Mental

Health, London, United Kingdom

§ Psychiatric Research Centre, Örebro, Sweden


Preparation (12/2002 - 08/2003 ): An English reference version of the questionnaires was agreed upon, translated into all national languages, piloted and validated in clinical practice and back-translated into English. An Internet-based database with a central server in Dresden has been set up. 12 national reports on the legal background of involuntary admission and treatment are being drawn up and integrated. The catchment areas covered by the study have been described with structured and internationally validated instruments with regard to their socio-demographics and mental health services. Local expert groups, involving professionals as well as users' and relatives' representatives have been formed.

Data gathering ( 09/2003 - 05/2005) : In each centre two groups of patients are being assessed: a) N=250 legally involuntarily admitted patients and b) N=75 legally voluntarily admitted patients who feel coerced to admission. Interviews are being conducted at three time points: T1) within the first ten days after admission, T2) four weeks after admission and T3) three months after admission - regardless of where the patient is currently staying. The interviews assess perceived coercion during hospital admission and hospital stay, current symptoms, treatment- and life-satisfaction. Data analysis in each of the two groups will be done with descriptive statistics, regression models and analyses of variance.

Involverade parter


information Added workplaces
Landsting - Region Örebro Län - Hälso- och sjukvård - Forskning och utbildning - Universitetssjukvårdens forskningscentrum workplace verified by Region Örebro län on 2018-02-27





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EUNOMIA-projektet, from FoU Region Örebro län