Ethnic differences in risk of acute compulsory admission in Amsterdam, 1996-2005

Determinants of compulsory admission in detainees with acute psychiatric symptoms in the French speaking counties of Switzerland

Compulsory admission (CA) refers to the process of hospitalization of an individual to a psychiatric ward or hospital, without their consent, due to severe mental health conditions. While it is an established and legally framed practice in many countries, it raises a number of ethical issues in terms of personal liberty and risks of potential misuse. Ethnicity, male gender and psychosis are the main risk factors for compulsory admission to psychiatric wards/hospitals in general population. Previous studies documented that CA is even more frequently used in prison, yet its determinants are still unknown. To address this issue, we explored the clinical, demographic and criminological determinants of compulsory admission in 317 detainees admitted to a psychiatric acute care secure ward located in the central prison of Geneva. We distinguished three groups: voluntary admissions only (VA), CA only and mixed admissions (MA). Judicial status and types of offenses were also recorded. Sociodemographic data included age, gender, and origin. Clinical parameters included previous compulsory admissions, previous hospital stays, number of admissions, length of stay, number of suicide attempts, short-term seclusions and ICD-10 clinical diagnoses. Fisher's exact, Chi2 and Kruskal Wallis tests were used for group comparisons. Logistic regression analysis was used to explore the association between the legal status of hospital stays and clinical diagnosis. There was no significant difference between the three groups in respect to sociodemographic factors. Past compulsory admissions were significantly more frequent in the CA compared to the VA group. Both the mean number of admissions and length of stay differed significantly between the three groups. The number of suicidal attempts was significantly higher in MA compared to both VA and CA groups. Short-term seclusion was significantly more frequent in CA and MA compared to VA. Psychotic disorders were much more frequent in CA (55.1%) and MA (54.8%) compared to VA cases (23.9%). In contrast, depressive and anxiety disorders were significantly less frequent in CA (12.3%) and MA (14.3%) than VA (29.5%). Of importance, neither the type of offenses nor the judicial status differed between the three groups. In regression models, CA was strongly and positively associated with psychotic disorders. The inverse was true for depressive, anxiety as well as adjustment disorders. The present findings reveal that, in contrast to the general population, sociodemographic factors have no impact on the frequency of CA in a population of detainees. The main risk factors for the adoption of this measure are past CA and presence of acute psychosis. In contrast, the presence of depressive and anxiety symptoms limits the recourse to this disputed measure.

Change in care needs of people with severe mental illness with and without a non-Western migration background: are their needs equally served throughout treatment?

BACKGROUND

People with a non-Western migration background living in Western countries are more likely to experience psychiatric problems and have more severe symptoms when they do. Patients of non-Western origin also have more unmet needs for care. This study focuses on differences between Western and non-Western patients in care needs being met during the course of mental health treatment.

METHODS

The care needs of 1099 patients, 39% with and 61% without a non-Western migration background, recorded between 2017 and 2020 in Flexible Assertive Community Treatment, were compared.

RESULTS

Non-Western migrants more often received psychotic disorder diagnoses, had more socio-economic problems, met, unmet and total needs for care and experienced less reduction in unmet needs during treatment. This was specifically the case for the rehabilitation areas: daily activities, treatment information, basic education, paid work and meaningful life and recovery. After controlling for socio-economic factors and diagnosis, group differences in change in number of unmet needs were no longer significant. However, the reduction in unmet needs in the areas of basic education, paid work and meaningful life and recovery remained significantly smaller for non-Western patients.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

Except for the rehabilitation domains of basic education, paid work and meaningful life, the disadvantages in resolving the care needs of patients with a non-Western migration background do not remain significant after taking into account socioeconomic factors and diagnosis. Collaboration of mental health care and the social domain is warranted to improve socio-economic factors for patients with a non-Western migration background, to better address their unmet needs for care.

Compulsory psychiatric admissions in the canton of Basel-Stadt between September 2013 and April 2022: Analysis of the cantonal database of the Health Department of Basel-Stadt

BACKGROUND

According to federal and cantonal law, persons with an acute mental illness can be admitted to a psychiatric hospital or another suitable institution against their will, when other therapeutic options are not available or have been exhausted. In the canton of Basel-Stadt, this is the responsibility of public health officers employed by the division of Social Medicine of the cantonal Health Department.

AIMS

This study aims to elucidate which factors influence the decision-making of public health officers regarding compulsory admissions over the period from September 2013 to April 2022 in the canton of Basel-Stadt.

METHOD

Leveraging comprehensive clinical data from the health department of the canton Basel-Stadt (N = 5,'550), we estimated a mixed effects logistic regression model to identify factors contributing to the decision of public-health officers to compulsorily admit patients, while controlling for potential clustering effects among public health officers.

RESULTS

The risk for compulsory admissions was most strongly predicted by the presence of potential self-harm. In comparison, while being a strong predictor, potential harm to others played a considerably lesser role. Furthermore, psychiatric syndrome, previous compulsory admissions, and the specific context of evaluation were significant predictors. Finally, we found no meaningful personal bias among public health officers.

CONCLUSION

The results suggest that public health officers' decision-making regarding compulsory admissions focuses on preventing self-harm and, to a lesser degree, harm to others. This indicates that such measures are only used as a measure of last resort, which is in line with current evidence regarding the detrimental effects of compulsory measures on treatment outcomes in psychiatry. Our findings suggest that all relevant stakeholders, including the police, share this perspective. Decision-making regarding compulsory admissions was mostly free of personal biases, suggesting adherence to shared professional standards by public health officers.

Compulsory and voluntary admissions in comparison: A 9-year long observational study

BACKGROUND

Few studies, so far, have been specifically designed to highlight the features related to Compulsory Admissions (CA) and Voluntary Admissions (VA) in Italian psychiatric emergency wards.

AIMS

The main purpose of this observational study was to compare the sociodemographic and clinical characteristics of VA and CA and to explore possible predictors of re-admissions.

METHODS

During a 6-month Index Period (February, the 1st-July, the 31st 2008) all psychiatric admissions were documented and then followed-up through all available informatic systems for the next 9 years.

RESULTS

Out of 390 hospitalizations, 101 (25.9%) were compulsory (CA rate was 2.79 per 10,000 inhabitants per year, mean duration of hospitalizations of 7.33 ± 7.84 days). Diagnoses were recorded for the 325 patients who had been hospitalized during index period: schizophrenic psychoses ([p = .042], in particular schizophrenia [p = .027]), manic episode (p = .044), and delusional disorders (p = .009) were associated with CA; conversely, the diagnosis of unipolar major depression (p = .005) and personality disorders (p = .048) were significantly more frequent in VA. The 325 admitted patients were followed up for 1,801 person-years. No significant differences were found in terms of drop-outs, transferring, and discharge rates, and mortality rates due to both natural causes and suicides. Factors associated with at least one compulsory readmission were younger age and having had a previous CA (p = .011); conversely having been engaged with psychiatric services for over 1 year prior to index hospitalization was protective for a subsequent CA (p = .013).

CONCLUSIONS

After a 40-year old political reform, the current study shows that, in a context of integrated outpatient and inpatient services, engagement with outpatient care may be protective for compulsory rehospitalization.

Reported immigration and medical coercion among immigrants referred to a cultural consultation service

Members of visible minorities are commonly targets of social coercion related to immigration and medical measures. Social coercion is associated with poor mental health outcomes and mistrust of medical services. This study will determine if Afro-Canadian immigrants referred to a Cultural Consultation Service (CCS) in Montreal report more or less medical and immigration coercion compared with other ethnic minorities. We reviewed the charts of 729 referrals to the CCS and gathered data on the 401 patients included in the study. Chi-square statistics examined the relation between minority group and self-reported coercion. Binary logistic regression models controlled for standard sociodemographic variables in addition to ethnicity, language barrier, length of stay in Canada since immigration, refugee claimant status, referral source, presence of psychosis in the main diagnosis, and presence of legal history. Patients were diverse and included 105 Afro-Canadians, 40 Latin Americans, 73 Arab and West Asians, 149 South Asians, and 34 East and Southeast Asians. Being Afro-Canadian was significantly and positively associated with medical coercion (p = .02, 95% CI = 1.15-4.57), while being South Asian was negatively and significantly associated with immigration coercion (p = .03, 95% CI = .29-.93). Members of visible minority communities are not equal in their reported experience of social coercion after arriving to Canada. Future research clarifying pathways to mental health care for immigrants and the experience of new Canadians in immigration and health care settings would give needed context to the findings of this study.

Compulsory admission at first presentation to services for psychosis: does ethnicity still matter? Findings from two population-based studies of first episode psychosis

OBJECTIVES

Compared with the majority population, those from minority ethnic groups in the UK are more likely to be admitted compulsorily during a first episode of psychosis (FEP). We investigated whether these disparities in pathways in to care continue.

METHODS

We analysed data from two first episode psychosis studies, conducted in the same geographical area in south London 15 years apart: the Aetiology and Ethnicity in Schizophrenia and Other Psychosis (AESOP) and the Clinical Record Interactive Search-First Episode Psychosis (CRIS-FEP) studies. The inclusion/exclusion criteria for case ascertainment for first episode psychosis were identical across the two studies. We performed multivariable logistic regression to estimate odds of compulsory admission by ethnic group, controlling for confounders.

PARTICIPANTS

Two hundred sixty-six patients with first episode psychosis, aged 18-64 years, who presented to mental health services in south London in 1997-1999 and 446 with FEP who presented in 2010-2012.

RESULTS

When the two samples  were compared, ethnic differences in compulsory admission appear to have remained the same for black African patients, i.e. three times higher than white British in both samples: AESOP (adj. OR = 3.96; 95% CI = 1.80-8.71) vs. CRIS-FEP (adj. OR = 3.12; 95% CI = 1.52-6.35). Black Caribbean patients were three times more likely to be compulsorily admitted in AESOP (adj. OR = 3.20; 95% CI = 1.56-6.54). This was lower in the CRIS-FEP sample (adj. OR = 1.68; 95% CI = 0.71-3.98) and did not meet conventional levels for statistical significance.

CONCLUSION

Ethnicity is strongly associated with compulsory admissions at first presentation for psychosis with evidence of heterogeneity across groups, which deserves further research.

Ethnic variations in compulsory detention under the Mental Health Act: a systematic review and meta-analysis of international data

BACKGROUND

Evidence suggests that black, Asian and minority ethnic (BAME) groups have an increased risk of involuntary psychiatric care. However, to our knowledge, there is no published meta-analysis that brings together both international and UK literature and allows for comparison of the two. This study examined compulsory detention in BAME and migrant groups in the UK and internationally, and aimed to expand upon existing systematic reviews and meta-analyses of the rates of detention for BAME populations.

METHODS

For this systematic review and meta-analysis, we searched five databases (PsychINFO, MEDLINE, Cochrane Controlled Register of Trials, Embase, and CINAHL) for quantitative studies comparing involuntary admission, readmission, and inpatient bed days between BAME or migrant groups and majority or native groups, published between inception and Dec 3, 2018. We extracted data on study characteristics, patient-level data on diagnosis, age, sex, ethnicity, marital status, and occupational status, and our outcomes of interest (involuntary admission to hospital, readmission to hospital, and inpatient bed days) for meta-analysis. We used a random-effects model to compare disparate outcome measures. We assessed explanations offered for the differences between minority and majority groups for the strength of the evidence supporting them. This study is prospectively registered with PROSPERO, number CRD42017078137.

FINDINGS

Our search identified 9511 studies for title and abstract screening, from which we identified 296 potentially relevant full-text articles. Of these, 67 met the inclusion criteria and were reviewed in depth. We added four studies after reference and citation searches, meaning 71 studies in total were included. 1 953 135 participants were included in the studies. Black Caribbean patients were significantly more likely to be compulsorily admitted to hospital compared with those in white ethnic groups (odds ratio 2·53, 95% CI 2·03-3·16, p<0·0001). Black African patients also had significantly increased odds of being compulsorily admitted to hospital compared with white ethnic groups (2·27, 1·62-3·19, p<0·0001), as did, to a lesser extent, south Asian patients (1·33, 1·07-1·65, p=0·0091). Black Caribbean patients were also significantly more likely to be readmitted to hospital compared with white ethnic groups (2·30, 1·22-4·34, p=0·0102). Migrant groups were significantly more likely to be compulsorily admitted to hospital compared with native groups (1·50, 1·21-1·87, p=0·0003). The most common explanations for the increased risk of detainment in BAME populations included increased prevalence of psychosis, increased perceived risk of violence, increased police contact, absence of or mistrust of general practitioners, and ethnic disadvantages.

INTERPRETATION

BAME and migrant groups are at a greater risk of psychiatric detention than are majority groups, although there is variation across ethnic groups. Attempts to explain increased detention in ethnic groups should avoid amalgamation and instead carry out culturally-specific, hypothesis-driven studies to examine the numerous contributors to varying rates of detention.

FUNDING

University College London Hospitals National Institute for Health Research (NIHR) Biomedical Research Centre, NIHR Biomedical Research Centre at South London and Maudsley NHS Foundation Trust, King's College London, and NIHR Collaboration for Leadership in Applied Health Research and Care North Thames at Bart's Health NHS Trust.

Ethnic variations regarding clinical profiles and symptom representation in prisoners with psychotic disorders

BACKGROUND

Black and minority ethnic (BME) groups are known to have higher prevalences of psychotic disorders and are over-represented in western penitentiaries and forensic psychiatric institutions. Research from regular mental healthcare settings suggests that they could show different and more severe psychotic symptoms. Aims To explore ethnic variations in severity of symptomatology of BME and non-BME detainees with psychotic disorders.

METHOD

In this study, 824 patients with psychotic disorders from seven different ethnic groups, imprisoned in a penitentiary psychiatric centre in the Netherlands, were compared on symptom severity and symptom representation using the BPRS-E clinical interview. Data were analysed by means of a multilevel analysis.

RESULTS

BME patients with psychotic disorders are over-represented in forensic psychiatry, and symptom profiles of prisoners with psychotic disorders vary by ethnicity. Additionally, severity levels of overall psychopathology differ between ethnic groups: patients with an ethnic majority status show more severe levels of psychopathology compared with BME patients.

CONCLUSIONS

There are differences in symptom severity and symptom profiles between BME patients and non-BME patients. Disregarding these differences could have an adverse effect on the outcome of the treatment. Possible explanations and clinical impact are discussed. Declaration of interest None.

Cost-effectiveness of 3-month paliperidone therapy for chronic schizophrenia in the Netherlands

BACKGROUND

A new depot formulation of paliperidone has been developed that provides effective treatment for schizophrenia for 3 months (PP3M). It has been tested in phase-3 trials, but no data on its cost-effectiveness have been published.

PURPOSE

To determine the cost-effectiveness of PP3M compared with once-monthly paliperidone (PP1M), haloperidol long-acting therapy (HAL-LAT), risperidone microspheres (RIS-LAT), and oral olanzapine (oral-OLZ) for treating chronic schizophrenia in The Netherlands.

METHODS

A previous 1-year decision tree was adapted, based on local inputs supplemented with data from published literature. The primary analysis used DRG costs in 2016 euros from the insurer perspective, as derived from official lists. A micro-costing analysis was also conducted. For the costing scenario, official list prices were used. Clinical outcomes included relapses (treated as outpatients, requiring hospitalization, total), and quality-adjusted life-years (QALYs). Rates and utility scores were derived from the literature. Economic outcomes were the incremental cost/QALY-gained or relapse-avoided. Model robustness was examined in scenario, 1-way, and probability sensitivity analyses.

RESULTS

The expected cost was lowest with PP3M (8,781€), followed by PP1M (10,325€), HAL-LAT (11,278€), RIS-LAT (11,307€), and oral-OLZ (13,556€). PP3M had the fewest total relapses/patient (0.36, 0.94, 1.39, 1.21, and 1.70, respectively), hospitalizations (0.11, 0.46, 0.40, 0.56, and 0.57, respectively), emergency room visits (0.25, 0.48. 0.99, 0.65, and 1.14, respectively) and the most QALYs (0.847, 0.735, 0.709, 0.719, and 0.656, respectively). In both cost-effectiveness and cost-utility analyses, PP3M dominated all other drugs. Sensitivity analyses confirmed base case findings. In the costing analysis, total costs were, on average, 31.9% higher than DRGs.

CONCLUSIONS

PP3M dominated all commonly used drugs. It is cost-effective for treating chronic schizophrenia in the Netherlands. Results were robust over a wide range of sensitivity analyses. For patients requiring a depot medication, such as those with adherence problems, PP3M appears to be a good alternative anti-psychotic treatment.

Incidence of schizophrenia among migrants in the Netherlands: a direct comparison of first contact and longitudinal register approaches

PURPOSE

To estimate the effect of selective sampling on first contact (FC) studies of the relation between migration and schizophrenia.

METHODS

We compared the FC method directly with a more inclusive longitudinal psychiatric register (LPR) method, by letting both methods estimate age and sex adjusted incidence rate ratios (IRR) in the population of The Hague aged 20-54 years, for the three largest migrant groups (first and second generation Caribbean, Turkish, and Moroccan) relative to the native Dutch population.

RESULTS

Both methods found that the adjusted IRR was higher for migrants than for native Dutch [all migrants IRR = 1.70 (95% Cl 1.30-2.21) for the LPR method and 1.91 (95% Cl 1.15-3.25) for the FC]. The IRR for Moroccans was significantly lower in the LPR [IRR 2.69 (95% 2.10-3.41)] than in the FC study [4.81 (3.41-6.68)]. The FC method was relatively more inclusive for migrants presenting at earlier ages or with shorter durations of prior treatment (DPT) than the native Dutch. This resulted in differential sampling and artificially higher IRRs for Moroccan and, to a lesser extent, Turkish migrants.

CONCLUSION

We confirm that the incidence of schizophrenia is raised twofold for migrants compared to nonmigrants. Using the LPR method, however, IRR estimates were less pronounced for most migrant groups than in a high quality FC study conducted in the same population. The FC method may overestimate the risk of schizophrenia for migrant groups who seek first mental health at a relatively younger age, or who present directly with schizophrenia.

Evidence of an excessive gender gap in the risk of psychotic disorder among North African immigrants in Europe: a systematic review and meta-analysis

PURPOSE

Epidemiological studies in the Netherlands have reported an excessive gender gap in the risk for non-affective psychotic disorder (NAPD) among immigrants from Morocco with a higher risk elevation in males compared to females. We examined the consistency of these findings and their generalizability to immigrants from the Maghreb (Mauritania, Morocco, Algeria, Tunisia and Libya) in other European countries.

METHODS

Systematic review and meta-analysis. Medline, PsychINFO and EMBASE databases were searched for publications in the period from January 1970 to April 2014. We included incidence and prevalence studies of non-affective psychotic disorder (NAPD) among migrants from the Maghreb in Europe and studies of subclinical psychotic symptoms (SPS) in representative samples. A meta-analysis was performed on the subgroup of incidence studies.

RESULTS

Five incidence and three prevalence studies of NAPD, and two prevalence studies of SPS, conducted in the Netherlands (n=7), Belgium (n=1), France (n=1) and Italy (n=1) met our inclusion criteria. Across all research designs, the risks of NAPD and SPS were consistently increased among male, not female immigrants from the Maghreb. The meta-analysis of incidence studies of NAPD yielded male-to-female risk ratios of 5.1 [95 % confidence interval (CI) 3.1-8.4] for migrants from the Maghreb, 2.0 (95 % CI 1.6-2.5) for other migrant groups, and 1.8 (95 % CI 1.3-2.5) for non-migrant Europeans.

CONCLUSIONS

The marked gender gap in psychosis risk among migrants from the Maghreb appears a consistent finding, foremost among the Moroccan-Dutch. The small number of studies limits the strength of conclusions that can be drawn about countries other than the Netherlands. Achievement-expectation mismatch, social marginalization and an increased prevalence of illicit drug use are possible explanations.

The association between ethnic background and characteristics of first mental health treatment for psychotic disorders in the Netherlands between 2001 and 2005

PURPOSE

To test the hypothesis that ethnic minority status of patients is associated with specific psychotic disorder treatment characteristics.

METHODS

Longitudinal data (2001-2005) were extracted from a nationwide psychiatric case register in the Netherlands. The sample consisted of 30,655 episodes of mental health treatment for 23,122 patients with psychotic disorders. Information was available about waiting time and treatment duration, source of referral, occurrence of crisis contacts, admittance to clinical care and compulsory admissions. In addition, information was available about ethnicity (based on country of birth), gender, age and marital status. Results were calculated for ethnic and gender groups separately. In addition, a number of multivariate regression analyses were conducted to correct for differences in age and marital status.

RESULTS

There was substantial variation between ethnic minority and gender groups in relation to the treatment characteristics. Compared with a Dutch ethnic background, ethnic minority background was generally associated with less waiting time, and more police referrals, crisis contacts, admittance to clinical care and compulsory admission, but shorter treatment duration. Characteristics appeared to be least favorable in episodes that involved male patients with Antillean and Surinamese backgrounds, whereas episodes were quite similar for ethnic Dutch and Turkish patients.

CONCLUSIONS

Characteristics of mental health treatment for psychosis in the Netherlands are different for ethnic minority patient groups than for patients with an ethnic Dutch background. However, there were substantial differences between ethnic minority groups.

Local Geographical Distribution of Acute Involuntary Psychiatric Admissions in Subdistricts In and Around Utrecht, the Netherlands

BACKGROUND

Acute involuntary psychiatric admissions (AIPA) tend to be applied more often in urban areas.

OBJECTIVE

The current study aims to describe AIPA prevalence differences between the subdistricts in an urban area, and to identify which district characteristics are associated with a higher AIPA district density.

METHODS

Information was collected on consecutive AIPAs over a 64-month period (2005-2010) in 49 subdistricts in and around the city of Utrecht, the Netherlands, including 1098 AIPAs. District characteristics included several demographic and economical factors and health care characteristics such as number of sheltered living facilities.

RESULTS

The AIPA density (mean 4.4/10,000 inhabitants/y) was four to five times higher in the most urbanized subdistrict (around 12) compared to the suburban subdistricts (2.5-3). On the district level, the main correlates with AIPA density per district were unemployment rate and small household size. Other correlates were percentage of non-Western immigrants and number of facilities of sheltered living.

CONCLUSIONS

The considerable AIPA density variation between subdistricts in this urban environment reflects that people who are prone to psychiatric admissions live in economically less prosperous environments. Impaired social networks and economic concerns may also contribute to an environment representing social defeat, increased demoralization, or social fragmentation.

A prediction model for the incidence of civil detention for crisis patients with psychiatric illnesses; the Amsterdam study of acute psychiatry VII

OBJECTIVE

Given raised numbers of civil detentions in the Netherlands and other European countries, it is important to assess the patient risk profile with respect to the incidence of those far-reaching treatment decisions. The aim of the ASAP study is to develop a comprehensive prediction model that considers all possible patient-related predictors known from earlier research.

METHODS

We took a random sample of 252 from the 2,682 patients coming into contact with two psychiatric emergency teams in Amsterdam between September 2004 and September 2006. We recorded socio-demographic and clinical characteristics, aspects of social support and psychiatric history. We interviewed the patients using the Verona Service Satisfaction Scale (Verona-EU) and the Birchwood Insight Scale. During a two-year follow-up period we noted their use of mental health care facilities.

RESULTS

Stepwise logistic regression analyses with resulted in a final prediction model (P ≤ 0.001) including preceding involuntary admission (OR 9.4, 95% CI 3.6-24.7, P ≤ 0.001), domestic situation alone (OR 4.5, 95% CI 1.9-11.0, P = 0.001) and VSSS score satisfactory (OR 0.2, 95% CI 0.0-0.8, P = 0.030) as predictors of civil detention during 2 years of follow-up.

CONCLUSION

With the presented prediction model it will be possible to identify patients at a high risk of civil detention: patients with a history of previous involuntary admissions who live alone and are not satisfied with the mental health care they got before. This suggests the possibility that timely preventive measures can be taken comprising the adjustment or intensification of the treatment plan for this specific group of patients.

Country of birth and hospital treatment for psychosis in New South Wales

BACKGROUND

Migration has been found to be a risk factor for schizophrenia in several high-income countries.

AIM

To examine whether overseas migrants to New South Wales (NSW) have higher rates of admission to psychiatric hospitals for psychotic disorders, including schizophrenia and mania, compared to people born in Australia.

METHODS

The country of birth of people admitted to public mental health units for the treatment of psychotic illness and for non-psychotic disorders between 2001 and 2010 was compared to the country of birth for the NSW population in the 2006 census. Meta-analysis was used to estimate the odds of being admitted for any psychotic disorder, for a schizophrenia-related psychosis and for mania compared to non-psychotic disorder, for those born in Australia, New Zealand and for nine global regions.

RESULTS

Those born in Oceania (including Melanesia, Fiji, Samoa, Tonga and other Polynesian islands, but excluding Hawaii and New Zealand) had the highest odds of admission for the treatment of psychosis compared to a non-psychotic disorder and had the highest odds of being admitted with a diagnosis of schizophrenia or mania.

CONCLUSIONS

In the years 2001-2010, those born in Oceania were at an increased risk of admission to NSW psychiatric hospitals for the treatment of psychotic illness.

Impact of psychiatrists' qualifications on the rate of compulsory admissions

Despite efforts to reduce coercion in psychiatry, involuntary hospitalizations remain frequent, representing more than half of all admissions in some European regions. Since October 2006, only certified psychiatrists are authorized to require a compulsory admission to our facility, while before all physicians were, including residents. The aim of the present study is to assess the impact of this change of procedure on the proportion compulsory admissions. All medical records of patients admitted respectively 4 months before and 4 month after the implementation of the procedure were retrospectively analyzed. This search retrieved a total of 2,227 hospitalizations for 1,584 patients. The overall proportions of compulsory and voluntary admissions were 63.9 % and 36.1 % respectively. The average length of stay was 32 days (SD ± 64.4). During the study period, 25 % of patients experienced two hospitalizations or more. The most frequent patients' diagnoses were affective disorders (30 %), psychotic disorders (18.4 %) and substance abuse disorders (15.7 %). Compared with the period before October 2006, patients hospitalized from October 2006 up were less likely to be hospitalized on a compulsory basis (OR = 0.745, 95 % CI: 0.596-0.930). Factors associated with involuntary admission were young age (20 years or less), female gender, a diagnosis of psychotic disorder and being hospitalized for the first time. Our results strongly suggest that limiting the right to require compulsory admissions to fully certified psychiatrists can reduce the rate of compulsory versus voluntary admissions.