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Müller M, Brackmann N, Homan P, Vetter S, Seifritz E, Ajdacic-Gross V, Hotzy F. Predictors for early and long-term readmission in involuntarily admitted patients. Compr Psychiatry 2024; 128:152439. [PMID: 38039919 DOI: 10.1016/j.comppsych.2023.152439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Revised: 11/01/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND It is a common aim to reduce psychiatric readmissions. Although risk factors for readmissions were described, specific data in the group of patients with potentially aversively experienced involuntary admissions are lacking. To better understand underlying mechanisms, it is important to identify factors that are linked to readmissions in this specific patient group, which is the purpose of the current paper. METHODS A four-year cohort of N = 3575 involuntary admissions (IA) was followed-up for subsequent re-hospitalization. Demographic, administrative and clinical factors associated with short- (within 30 days) or long-term (> 30 days) readmissions were examined using logistic regression modelling. RESULTS Almost half of all IA cases were readmitted within the observation period, whereof every fifth readmission was within the first month after discharge from the involuntary index hospitalization. Adjusted regression modelling revealed problematic substance use at admission and assisted living or homelessness as risk factors for readmission, while high functioning at discharge, anxiety disorders, no subsequent treatment after discharge or IA due to danger to others were negatively associated with readmission. Factors specifically linked to short-term readmission were substance use and personality disorders, abscondence or discharge by initiation of the clinic, as well as being discharged to any place except the patient's home. There were no specific risk-factors for long-term readmission. CONCLUSIONS To prevent readmissions after IA, especially for patients at risk, the aim of treatment strategies should be to focus on intensive discharge planning, enable continuous treatment in the outpatient setting, and provide social support.
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Affiliation(s)
- Mario Müller
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland.
| | - Nathalie Brackmann
- Department of Forensic Psychiatry, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland.
| | - Philipp Homan
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland.
| | - Stefan Vetter
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland.
| | - Erich Seifritz
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland.
| | - Vladeta Ajdacic-Gross
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland.
| | - Florian Hotzy
- Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital Zurich, University of Zurich, Lenggstrasse 31, 8032 Zürich, Switzerland.
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2
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Schneider M, Back M, Krückl JS, Moeller J, Lang UE, Huber CG. 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. Int J Soc Psychiatry 2022:207640221141020. [PMID: 36453089 DOI: 10.1177/00207640221141020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
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.
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Affiliation(s)
- Michael Schneider
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Moritz Back
- Health Department of Basel-Stadt, Cantonal Medical Service, Social Medicine, Basel, Switzerland
| | - Jana S Krückl
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Julian Moeller
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
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3
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Draghetti S, Alberti S, Borgiani G, Panariello F, De Ronchi D, Atti AR. Compulsory and voluntary admissions in comparison: A 9-year long observational study. Int J Soc Psychiatry 2022; 68:1716-1726. [PMID: 34927496 DOI: 10.1177/00207640211057731] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
- Stefano Draghetti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Siegfried Alberti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Gianluca Borgiani
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Fabio Panariello
- Servizio Psichiatrico di Diagnosi e Cura "P. Ottonello" - Azienda Sanitaria Locale di Bologna, Italy
| | - Diana De Ronchi
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
| | - Anna Rita Atti
- Department of Biomedical and Neuromotor Sciences, University of Bologna, Italy
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Saini P, Martin A, McIntyre J, Balmer A, Burton S, Roks H, Sambrook L, Shetty A, Nathan R. COMplex mental health PAThways (COMPAT) Study: A mixed methods study to inform an evidence-based service delivery model for people with complex needs: Study protocol. PLoS One 2022; 17:e0264173. [PMID: 35259173 PMCID: PMC8903266 DOI: 10.1371/journal.pone.0264173] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 02/06/2022] [Indexed: 11/18/2022] Open
Abstract
Background
Mental health services for adults, as they are currently configured, have been designed to provide predominantly community-based interventions. It has long been recognised that some patients have such significant clinical and/or risk needs that those needs cannot be adequately met within standard service delivery models, resulting in a pressing need to consider the best models for this group of people. This paper shares a protocol for a mixed methods study that aims to understand: the profile and history of service users described as having complex needs; the decision-making processes by clinicians that lead to complex needs categorisation; service users and carers experience of service use; and, associated economic impact. This protocol describes a comprehensive evaluation that aims to inform an evidence-based service delivery model for people with complex needs.
Methods
We will use a mixed methods design, combining quantitative and qualitative methods using in-depth descriptive and inferential analysis of patient records, written medical notes and in-depth interviews with service users, carers, and clinicians. The study will include five components: (1) a quantitative description and analysis of the demographic clinical characteristics of the patient group; (2) an economic evaluation of alternative patient pathways; (3) semi-structured interviews about service user and carer experiences; (4) using data from components 1–3 to co-produce vignettes jointly with relevant stakeholders involved in the care of service users with complex mental health needs; and, (5) semi-structured interviews about clinical decision-making by clinicians in relation to this patient group, using the vignettes as example case studies.
Discussion
The study’s key outcomes will be to: examine the resource use and cost-impact associated with alternative care pathways to the NHS and other sectors of the economy (including social care); explore patient health and non-health outcomes associated with alternative care pathways; and, gain an understanding of a complex service user group and how treatment decisions are made to inform consistent and person-centred future service delivery.
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Affiliation(s)
- Pooja Saini
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- * E-mail:
| | | | - Jason McIntyre
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Anna Balmer
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Sam Burton
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Hana Roks
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Laura Sambrook
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
| | - Amrith Shetty
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
| | - Rajan Nathan
- Faculty of Health, Liverpool John Moores University, Liverpool, United Kingdom
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
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5
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Bhalla IP, Siegel K, Chaudhry M, Li N, Torbati S, Nuckols T, Danovitch I. Involuntary Psychiatric Hospitalization: How Patient Characteristics Affect Decision-Making. Psychiatr Q 2022; 93:297-310. [PMID: 34536188 DOI: 10.1007/s11126-021-09939-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2021] [Indexed: 10/20/2022]
Abstract
Emergency department (ED) psychiatrists face the consequential decision to pursue involuntary inpatient psychiatric admission. Research on the relationship between patient characteristics and the decision to pursue involuntary psychiatric admission is limited. Using data from 2017 to 2018 at an urban Los Angeles hospital, we used generalized linear mixed effects models to compare patients who were involuntarily admitted to inpatient psychiatry to patients who were discharged from the ED. Of 2,448 patients included in the study, 1,217 (49.7%) were involuntarily admitted to inpatient psychiatry and 1,231 (50.3%) were discharged. After controlling for sociodemographic characteristics, admitted patients were more likely to have been brought in by police, have had an organized suicide plan or recent attempt, physical signs of harm, psychosis, depression or hopelessness, lack social support, have diagnoses of schizophrenia or bipolar disorder, and be administered injectable psychotropic medications. Stimulant use, a diagnosis of anxiety or developmental disorders, and recent medical ED utilization were associated with discharge. Psychiatrists pursued involuntarily psychiatric hospitalization based on factors potentially indicative of dangerousness, leaving patients, particularly those with recent substance use, without immediate access to treatment. Policies should focus on increasing follow up to high quality, voluntary outpatient mental health care.
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Affiliation(s)
- Ish P Bhalla
- National Clinician Scholars Program At UCLA Funded By Cedars-Sinai Medical Center and the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA. .,Cedars-Sinai Medical Center, Los Angeles, CA, USA. .,David Geffen School of Medicine At UCLA, Department of General Internal Medicine, Los Angeles, CA, USA.
| | - Keith Siegel
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | | | - Ning Li
- David Geffen School of Medicine At UCLA, Department of General Internal Medicine, Los Angeles, CA, USA
| | - Sam Torbati
- Cedars-Sinai Medical Center, Los Angeles, CA, USA
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6
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Moetteli S, Heinrich R, Jaeger M, Amodio C, Roehmer J, Maatz A, Seifritz E, Theodoridou A, Hotzy F. Psychiatric Emergencies in the Community: Characteristics and Outcome in Switzerland. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2021; 48:1055-1064. [PMID: 33608861 PMCID: PMC8502162 DOI: 10.1007/s10488-021-01117-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2021] [Indexed: 10/24/2022]
Abstract
Psychiatric emergencies occur frequently in the community setting, e.g. the patient's home or public places. Little is known about the characteristics and outcome of these situations. This study describes psychiatric emergencies in the canton of Zurich, Switzerland, and examines determinants of their outcome. We retrospectively analyzed 620 medical records of consultations classified as psychiatric emergencies of a 24/7 service of community-based emergency physicians. Information on sociodemographic, clinical and situational factors was extracted. The observation period was 6 months in 2017. Binary logistic regression was used to examine predictors for involuntary admissions. Most emergency consultations (64.5%) took place at the patient's home, followed by police stations (31.0%), public places (3.2%), and somatic hospitals (1.3%). Patient characteristics and reasons for consultation varied considerably between the locations. The first involved person was commonly a relative. Of all consultations, 38.4% resulted in involuntary admissions, mainly in patients with psychosis, suicidality, aggression, refusal of necessary treatment and previous involuntary admissions. Situation-related factors and the involvement of relatives were no significant predictors of the outcome. Psychiatric emergencies occur in different places and in patients with a variety of psychiatric symptoms. Although half of the emergency situations were resolved in the community, the rate of involuntary admissions was still high. For additional reduction, the further development of quickly available alternatives to psychiatric inpatient treatment is required. These should be specifically geared towards acute situations in patients with the described risk factors. Additionally, the role of relatives during psychiatric emergencies should be further studied.
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Affiliation(s)
- Sonja Moetteli
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | | | | | | | | | - Anke Maatz
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Erich Seifritz
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Florian Hotzy
- Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.
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7
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Nathan R, Gabbay M, Boyle S, Elliott P, Giebel C, O'Loughlin C, Wilson P, Saini P. Use of Acute Psychiatric Hospitalisation: A Study of the Factors Influencing Decisions to Arrange Acute Admission to Inpatient Mental Health Facilities. Front Psychiatry 2021; 12:696478. [PMID: 34262495 PMCID: PMC8273335 DOI: 10.3389/fpsyt.2021.696478] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 05/14/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Human decision-making involves a complex interplay of intra- and inter-personal factors. The decisions clinicians make in practise are subject to a wide range of influences. Admission to a psychiatric hospital is a major clinical intervention, but the decision-making processes involved in admissions remain unclear. Aims: To delineate the range of factors influencing clinicians' decisions to arrange acute psychiatric admissions. Methods: We undertook six focus groups with teams centrally involved in decisions to admit patients to hospital (crisis resolution home treatment, liaison psychiatry, approved mental health practitioners and consultant psychiatrists). The data were analysed using qualitative thematic analysis. Results: Our analysis of the data show a complex range of factors influencing decision-making that were categorised as those related to: (i) clinical and risk factors; (ii) fear/threat factors; (iii) interpersonal dynamics; (iv) contextual factors. Conclusions: Decisions to arrange acute admission to hospital are not just based on an appraisal of clinical and risk-related information. Emotional, interpersonal and contextual factors are also critical in decision-making. Delineating the breadth of factors that bear on clinical decision-making can inform approaches to (i) clinical decision-making research, (ii) the training and supervision of clinicians, and (iii) service delivery models.
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Affiliation(s)
- Rajan Nathan
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
| | - Mark Gabbay
- NIHR CLAHRC NWC, Liverpool, United Kingdom.,Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Sean Boyle
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
| | - Phil Elliott
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
| | - Clarissa Giebel
- NIHR CLAHRC NWC, Liverpool, United Kingdom.,Institute of Population Health Sciences, University of Liverpool, Liverpool, United Kingdom
| | - Carl O'Loughlin
- Cheshire and Wirral Partnership NHS Foundation Trust, Chester, United Kingdom
| | - Pete Wilson
- Health Education North West, Manchester, United Kingdom
| | - Pooja Saini
- School of Psychology, Liverpool John Moores University, Liverpool, United Kingdom
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8
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Voluntary and involuntary admissions with schizoaffective disorder: do they differ from schizophrenia? Ir J Psychol Med 2020:1-8. [PMID: 33272341 DOI: 10.1017/ipm.2020.123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES Schizoaffective disorder and schizophrenia are common presentations to psychiatry services. Research to date has focussed on hypothesised biological differences between these two disorders. Little is known about possible variations in admission patterns. Our study compared demographic and clinical features of patients admitted voluntarily and involuntarily with diagnoses of schizoaffective disorder or schizophrenia to three psychiatry admission units in Ireland. METHODS We studied all admissions to three acute psychiatry units in Ireland for periods between 1 January 2008 and 31 December 2018. We recorded demographic and clinical variables for all admissions. Voluntary and involuntary admissions of patients with schizoaffective disorder were compared to those with schizophrenia. RESULTS We studied 5581 admissions to the study units for varying periods between January 2008 and December 2018, covering a total of 1 976 154 person-years across the 3 catchment areas. The 3 study areas had 218.8, 145.5 and 411.2 admissions per 100 000 person-years, respectively. Of the 5581 admissions over the study periods, schizoaffective disorder accounted for 5% (n = 260) and schizophrenia for 17% (n = 949). Admissions with schizoaffective disorder were significantly more likely to be female and older, and less likely to have involuntary admission status, compared to those with schizophrenia. As first admissions were not distinguished from re-admissions in this dataset, these findings merit further study. CONCLUSIONS Admissions with a schizoaffective disorder differ significantly from those with schizophrenia, being, in particular, less likely to be involuntary admissions. This suggests that psychotic symptoms might be a stronger driver of involuntary psychiatry admission than affective symptoms.
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9
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Plahouras JE, Mehta S, Buchman DZ, Foussias G, Daskalakis ZJ, Blumberger DM. Experiences with legally mandated treatment in patients with schizophrenia: A systematic review of qualitative studies. Eur Psychiatry 2020; 63:e39. [PMID: 32406364 PMCID: PMC7355163 DOI: 10.1192/j.eurpsy.2020.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background: Patients with severe mental illness, including schizophrenia, may be legally mandated to undergo psychiatric treatment. Patients’ experiences in these situations are not well characterized. This systematic review of qualitative studies aims to describe the experiences of patients with schizophrenia and related disorders who have undergone legally mandated treatment. Methods: Four bibliographic databases were searched: CINAHL Plus (1981–2019), EMBASE (1947–2019), MEDLINE (1946–2019), and PsycINFO (1806–2019). These databases were searched for keywords, text words, and medical subject headings related to schizophrenia, legally mandated treatment and patient experience. The reference lists of included studies and systematic reviews were also investigated. The identified titles and abstracts were reviewed for study inclusion. A thematic analysis was completed for the synthesis of positive and negative aspects of legally mandated treatment. Results: A total of 4,008 citations were identified. Eighteen studies were included in the final synthesis. For the thematic analysis, results were collated under two broad themes; positive patient experiences and negative patient experiences. Patients were satisfied when their autonomy was respected, and dissatisfied when it was not. Patients often retrospectively recognized that their treatment was beneficial. Furthermore, negative aspects of the treatment included deficits in communication and a lack of information. Conclusions: Intervention research has historically focused on clinical outcomes and the quantitative aspects of treatment. Thus, this study provides insight into the qualitative aspects of patients’ experiences with legally mandated treatment. Recognizing these opinions and experiences can lead to better attitudes toward treatment for patients with schizophrenia and related psychiatric illnesses.
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Affiliation(s)
- Joanne E Plahouras
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, OntarioCanada
| | - Shobha Mehta
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, OntarioCanada
| | - Daniel Z Buchman
- Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada.,Bioethics Department, Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Krembil Brain Institute, University Health Network, Toronto, Ontario, Canada
| | - George Foussias
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Schizophrenia Division, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Zafiris J Daskalakis
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, OntarioCanada.,Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Daniel M Blumberger
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Temerty Centre for Therapeutic Brain Intervention, Centre for Addiction and Mental Health, Toronto, OntarioCanada.,Campbell Family Mental Health Institute, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
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10
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Yang Y, Li W, Lok KI, Zhang Q, Hong L, Ungvari GS, Bressington DT, Cheung T, Xiang YT. Voluntary admissions for patients with schizophrenia: A systematic review and meta-analysis. Asian J Psychiatr 2020; 48:101902. [PMID: 31896433 DOI: 10.1016/j.ajp.2019.101902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Revised: 11/19/2019] [Accepted: 12/13/2019] [Indexed: 10/25/2022]
Abstract
AIMS Voluntary admission rates of schizophrenia vary widely across studies. In order to make the topic be informed by evidence, it is important to have accurate estimates. This meta-analysis examined the worldwide prevalence of voluntary admissions for patients with schizophrenia. METHOD PubMed, EMBASE, PsycINFO, the Cochrane Library, Web of Science and Medline databases were systematically searched, from their commencement date until 19th November 2018. Meta-analysis of included studies was performed using the random-effects model. RESULTS Thirty-five studies with 134,100 schizophrenia patients were included. The overall voluntary admission rate of schizophrenia was 61.9 % (95 %CI: 52.3 %-70.7 %), while the involuntary rate was 43.0 % (95 %CI: 34.8 %-51.7 %). Subgroup analyses revealed that patients in Europe had significantly higher voluntary admission rates, while their North American counterparts were more likely admitted involuntarily. Papers published prior to 2008 reported higher involuntary admission rates. Meta-regression analyses showed that higher male percentage and higher study quality were significantly associated with higher voluntary admission rate. CONCLUSION Although the worldwide prevalence of voluntary admissions was higher than that of involuntary admissions, the latter was common for schizophrenia. With the continuing liberalization of mental health laws broadening community-based psychiatric services, the rate of voluntary psychiatric admissions is expected to further increase over time.
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Affiliation(s)
- Yuan Yang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau; Department of Psychiatry, Southern Medical University Nanfang Hospital, Guangdong, China
| | - Wen Li
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Ka-In Lok
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau
| | - Qinge Zhang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital & the Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China
| | - Liu Hong
- Department of Psychiatry and Mental Health, Guangdong Medical University, Guangdong, China; Department of Psychiatry, Shunde WuZhongpei Memorial Hospital, Foshan, Guangdong, China
| | - Gabor S Ungvari
- University of Notre Dame Australia, Fremantle, Australia; Division of Psychiatry, School of Medicine, University of Western Australia, Perth, Australia
| | | | - Teris Cheung
- School of Nursing, Hong Kong Polytechnic University, Hong Kong, China
| | - Yu-Tao Xiang
- Unit of Psychiatry, Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macau.
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11
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Walker S, Mackay E, Barnett P, Sheridan Rains L, Leverton M, Dalton-Locke C, Trevillion K, Lloyd-Evans B, Johnson S. Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis. Lancet Psychiatry 2019; 6:1039-1053. [PMID: 31777340 PMCID: PMC7029280 DOI: 10.1016/s2215-0366(19)30406-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce involuntary hospitalisation. We did a systematic review, meta-analysis, and narrative synthesis to investigate risk factors at the patient, service, and area level associated with involuntary psychiatric hospitalisation of adults. METHODS We searched MEDLINE, PsycINFO, Embase, and the Cochrane Controlled Clinical Register of Trials from Jan 1, 1983, to Aug 14, 2019, for studies comparing the characteristics of voluntary and involuntary psychiatric inpatients, and studies investigating the characteristics of involuntarily hospitalised individuals in general population samples. We synthesised results using random effects meta-analysis and narrative synthesis. Our review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered on PROSPERO, CRD42018095103. FINDINGS 77 studies were included from 22 countries. Involuntary rather than voluntary hospitalisation was associated with male gender (odds ratio 1·23, 95% CI 1·14-1·32; p<0·0001), single marital status (1·47, 1·18-1·83; p<0·0001), unemployment (1·43, 1·07-1·90; p=0·020), receiving welfare benefits (1·71, 1·28-2·27; p<0·0001), being diagnosed with a psychotic disorder (2·18, 1·95-2·44; p<0·0001) or bipolar disorder (1·48, 1·24-1·76; p<0·0001), and previous involuntary hospitalisation (2·17, 1·62-2·91; p<0·0001). Using narrative synthesis, we found associations between involuntary psychiatric hospitalisation and perceived risk to others, positive symptoms of psychosis, reduced insight into illness, reduced adherence to treatment before hospitalisation, and police involvement in admission. On a population level, some evidence was noted of a positive dose-response relation between area deprivation and involuntary hospitalisation. INTERPRETATION Previous involuntary hospitalisation and diagnosis of a psychotic disorder were factors associated with the greatest risk of involuntary psychiatric hospitalisation. People with these risk factors represent an important target group for preventive interventions, such as crisis planning. Economic deprivation on an individual level and at the population level was associated with increased risk for involuntary hospitalisation. Mechanisms underpinning the risk factors could not be identified using the available evidence. Further research is therefore needed with an integrative approach, which examines clinical, social, and structural factors, alongside qualitative research into clinical decision-making processes and patients' experiences of the detention process. FUNDING Commissioned by the Department of Health and funded by the National Institute of Health Research (NIHR) via the NIHR Mental Health Policy Research Unit.
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Affiliation(s)
- Susan Walker
- Division of Psychiatry, University College London, London, UK; Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Euan Mackay
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Phoebe Barnett
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Luke Sheridan Rains
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | - Christian Dalton-Locke
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Kylee Trevillion
- National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
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Feeney A, Umama-Agada E, Gilhooley J, Asghar M, Kelly BD. Gender, diagnosis and involuntary psychiatry admission in Ireland: A report from the Dublin Involuntary Admission Study (DIAS). INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2019; 66:101472. [PMID: 31706388 DOI: 10.1016/j.ijlp.2019.101472] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/09/2019] [Indexed: 06/10/2023]
Abstract
Involuntary admission and treatment are common, long-standing features of psychiatry but the relationships between gender, diagnosis and other features of involuntary treatment are not clear. We studied all voluntary and involuntary psychiatry admissions at Tallaght University Hospital, Dublin over 2 years (n = 1230). Admission rates in Tallaght were lower than national rates for all admissions (224.9 admissions per 100,000 population per year in Tallaght versus 376.8 nationally), voluntary admissions (194.0 versus 328.4) and involuntary admissions (30.9 versus 48.4). Compared to men, proportionately fewer admissions of admissions of women were involuntary (11% versus 16%) and women were more commonly diagnosed with affective (mood) disorders (29.5% of women versus 22.6% of men), neuroses (anxiety disorders) (14.0% versus 8.8%) and personality and behavioural disorders (18.0% versus 9.2%), and less commonly diagnosed with schizophrenia group disorders (21.8% versus 32.0%), alcohol disorders (2.9% versus 4.3%) and drug disorders (3.6% versus 8.1%). Schizophrenia group disorders accounted for a greater proportion of male (63.2%) than female (55.6%) involuntary admissions, and affective disorders accounted for a greater proportion of female (17.5%) than male (12.3%) involuntary admissions. Duration of admission was independently associated with, in order of strength of association, involuntary status, schizophrenia group disorders and increasing age, but duration of involuntary care was not associated with any of these factors. The chief gender-related features of involuntary psychiatry admission are that (a) proportionately fewer admissions of admissions of women are involuntary compared to men, and (b) diagnoses of affective disorders are more common in women, and schizophrenia group diagnoses more common in men. Future research could usefully explore gender differences in grounds for involuntary detention and police involvement in the involuntary admission process. Future research is also warranted into whether gender associations differ in older compared to younger involuntary patients.
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Affiliation(s)
- Anna Feeney
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24 D24 NR0A, Ireland.
| | - Emmanuel Umama-Agada
- Kells Adult Mental Health Services, An Táin Suite, 1st Floor, Beaufort House, Navan, Co Meath C15 N82V, Ireland
| | - Jane Gilhooley
- National Forensic Mental Health Service, Central Mental Hospital, Dundrum Road, Dublin 14 D14 W0V6, Ireland
| | - Muhammad Asghar
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24 D24 NR0A, Ireland
| | - Brendan D Kelly
- Department of Psychiatry, Trinity College Dublin, Trinity Centre for Health Sciences, Tallaght University Hospital, Dublin 24 D24 NR0A, Ireland
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Lin CE, Chung CH, Chen LF, Chien WC. Does Compulsory Admission Prevent Inpatient Suicide Among Patients with Schizophrenia? A Nationwide Cohort Study in Taiwan. Suicide Life Threat Behav 2019; 49:966-979. [PMID: 30079449 DOI: 10.1111/sltb.12497] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 04/25/2018] [Indexed: 01/24/2023]
Abstract
OBJECTIVE The aim of this study was to analyze the risk of inpatient suicide in patients with schizophrenia during 2007-2013 and to determine putative risk factors. METHODS We conducted a national population-based cohort study of 2,038 psychiatric inpatients in their first compulsory admission, matched with 8,152 controls who were voluntary inpatients. Only patients with schizophrenia were included in the study. We used data derived from the Taiwanese National Health Insurance Database 2005, comprising 1 million beneficiaries randomly selected from the entire population of Taiwan. RESULTS During the follow-up period, 23 and 75 inpatient suicides were observed in the compulsory and control groups, respectively. Kaplan-Meier curves showed that the cumulative incidence rate of inpatient suicide was not significantly different between compulsory and voluntary admissions (log-rank test, p = .206). CONCLUSIONS Our results suggest that compulsory admission has no protective effects on risk reduction of inpatient suicide for patients with schizophrenia who are compulsorily admitted compared with voluntarily admitted controls. Clinicians should be more alert for the prevention of inpatient suicide among patients with schizophrenia and consider the close monitoring of inpatient suicide risk in the first week of admission.
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Affiliation(s)
- Ching-En Lin
- Department of Psychiatry, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan.,School of Medicine, Tzu-Chi University, Hualien, Taiwan
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.,School of Public Health, National Defense Medical Centre, Taipei, Taiwan
| | - Li-Fen Chen
- School of Medicine, National Defense Medical Center, Taipei, Taiwan.,Department of Psychiatry, Tri-Service General Hospital, Penhu Branch, Taipei, Taiwan
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, Taipei, Taiwan.,School of Public Health, National Defense Medical Centre, Taipei, Taiwan.,Graduate Institute of Life Sciences, National Defense Medical Centre, Taipei, Taiwan
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Clinical and socio-demographic characteristics associated with involuntary admissions in Switzerland between 2008 and 2016: An observational cohort study before and after implementation of the new legislation. Eur Psychiatry 2019; 59:70-76. [PMID: 31079010 DOI: 10.1016/j.eurpsy.2019.04.004] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Revised: 04/01/2019] [Accepted: 04/12/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Involuntary admission (IA) for psychiatric treatment has a history of controversial discussions. We aimed to describe characteristics of a cohort of involuntarily compared to voluntarily admitted patients regarding clinical and socio-demographic characteristics before and after implementation of the new legislation. METHODS In this observational cohort study, routine data of 15'125 patients who were admitted to the University Hospital of Psychiatry Zurich between 2008 and 2016 were analyzed using a series of generalized estimating equations. RESULTS At least one IA occurred in 4'560 patients (30.1%). Of the 31'508 admissions 8'843 (28.1%) were involuntary. In the final multivariable model, being a tourist (OR = 3.5) or an asylum seeker (OR = 2.3), having a schizophrenic disorder (OR = 2.1), or a bipolar disorder (OR = 1.8) contributed most to our model. Male gender, higher age, prescription of neuroleptics (all OR < 2.0) as well as having a depressive disorder, prescription of psychotherapy, prescription of antidepressants and admission after implementation of the new legislation (all OR > 0.6) were also weakly associated with IA. CONCLUSIONS Besides schizophrenic or bipolar disorders, a small group of patients had an increased risk for IA due to non-clinical parameters (i.e. tourists and asylum seekers). Knowledge about risk factors should be used for the development of multi-level strategies to prevent frequent (involuntary) hospitalizations in patients at risk. On the organizational level, we could show that the new legislation decreased the risk for IA, and therefore may have succeeded in strengthening patient autonomy.
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Silva B, Golay P, Morandi S. Factors associated with involuntary hospitalisation for psychiatric patients in Switzerland: a retrospective study. BMC Psychiatry 2018; 18:401. [PMID: 30594163 PMCID: PMC6311042 DOI: 10.1186/s12888-018-1966-6] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 11/29/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the scarce evidence for patients' benefits of coercion and its well-documented negative effects, the use of compulsion is still very common around Europe, with important variations among different countries. These variations have been partially explained by the different legal frameworks, but also by several individual-related, system-related and area-related characteristics, identified as predictors of the use of coercive measures. This study aimed to compare the socio-demographic and clinical profile as well as the referral and hospitalisation process of people voluntarily and involuntarily hospitalized in order to identify which factors could be associated with the use of coercion. METHODS All psychiatric admissions occurred between the 1st January 2015 and the 31st December 2015 were included in this retrospective study (n = 5027). The whole sample was split into two subgroups accordingly to the hospitalisation legal status at admission (voluntary vs involuntary) and differences between the two groups were examined. In order to identify the factors associated with coercion, all the variables reaching a p < .01 level of significance when comparing the two groups were included as independent variables into a multivariate logistic regression model. RESULTS Globally, 62% of the admissions were voluntary and 38% were involuntary. Compared to the voluntary group, involuntary patients were significantly older, more frequently widowed and living in one specific district, and had a main diagnosis of schizophrenia (F20-F29) or organic mental disorders (F00-F09). People affected by organic mental disorders (F00-F09), with higher levels of psychotic symptoms, aggression and problems with medication adherence, were more likely to be involuntarily admitted. Moreover, living in District 1, being referred by a general practitioner, a general hospital or a psychiatric hospital and being involuntarily admitted during the previous 12 months, was associated with a higher risk of coercion. CONCLUSIONS This study identified several individual-related, as well as system-related factors associated with the use of coercion. These results allowed us to trace a clearer profile of high-risk patients and to provide several inputs that could help local authorities, professionals and researchers to develop better-targeted alternative interventions reducing the use of coercion.
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Affiliation(s)
- Benedetta Silva
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland.
| | - Philippe Golay
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
| | - Stéphane Morandi
- Social Psychiatry Section, Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital (CHUV), Place Chauderon 18, 1003, Lausanne, Switzerland
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Godet T, Niveau G. Psychiatric care without consent in France: Does the type of administrative measure chosen differ according to patients' clinical profile? INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2018; 61:76-80. [PMID: 30206005 DOI: 10.1016/j.ijlp.2018.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Revised: 08/23/2018] [Accepted: 08/23/2018] [Indexed: 06/08/2023]
Abstract
The French Mental Health Law of 5 July 2011 stipulates that psychiatric patients can be hospitalized in five different ways. Three types of admission for involuntary treatment are defined under "admission at the request of a third party". The first is "psychiatric care at the request of a third party", followed by two "exceptional" admission measures in the case of an emergency ("emergency psychiatric care at the request of a third party") and imminent danger ("psychiatric care in the case of imminent danger"). The aim of this retrospective study was to determine whether the demographic and clinical characteristics of patients involuntarily admitted to psychiatric care in a French regional teaching hospital differed according to the administrative measure enabling this type of placement. We reviewed a sample of admission medical certificates issued between 1 July 2014 and 30 June 30, 2015 at the Tours University Hospital (France) for psychiatric care without consent. We recorded the following patient characteristics. Collected data included the type of care measure, age, gender, and the presence or absence of various clinical syndromes, such as suicidal thoughts and behavioral, depressive, manic or psychotic disorders. Multivariable analysis showed that a psychotic syndrome was a risk factor for hospitalization under "exceptional" measures and a behavioral syndrome for hospitalization under "psychiatric care at the request of a third party". Several clinical profiles emerged, but suicidal thoughts did not appear to be associated with the type of measures taken. In our sample, the choice of measure applied does not appear to rely on the only clinical observation at admission, contrary to what was planned in the Law.
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Affiliation(s)
- Tony Godet
- Forensic Psychiatry Unit, Geneva University Hospitals, 11 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland.
| | - Gérard Niveau
- Forensic Psychiatry Unit, Geneva University Hospitals, 11 Rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland
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Canova Mosele PH, Chervenski Figueira G, Antônio Bertuol Filho A, Ferreira de Lima JAR, Calegaro VC. Involuntary psychiatric hospitalization and its relationship to psychopathology and aggression. Psychiatry Res 2018; 265:13-18. [PMID: 29680512 DOI: 10.1016/j.psychres.2018.04.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Revised: 03/15/2018] [Accepted: 04/11/2018] [Indexed: 12/01/2022]
Abstract
The current study investigates the relationship between involuntary hospitalization, severity of psychopathology, and aggression. Adult psychiatric inpatients hospitalized from August, 2012 to January, 2013 were evaluated via the Brief Psychiatric Rating Scale (BPRS) and the Overt Aggression Scale (OAS). Individuals were compared regarding voluntariness of hospitalization. Of the 137 hospitalizations in the period, 71 were involuntary (INV). The variables associated with involuntariness were being brought to hospital by ambulance or police, and aggression in the first 24 h of admission. Risk of suicide at admission, and having personal income were associated with voluntariness. The dimensions of the BPRS associated with involuntary hospitalization were activation, resistance, and positive symptoms. Involuntary psychiatric hospitalization was associated with agitation, psychosis and aggression. The data support the indication of involuntary hospitalization for treatment of patients with severe mental illness.
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Affiliation(s)
- Pedro Henrique Canova Mosele
- Psychiatry Residence, University Hospital of Santa Maria, Santa Maria, RS, Brazil; Department of Neuropsychiatry, Federal University of Santa Maria, Santa Maria, RS, Brazil.
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18
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Hung YY, Chan HY, Pan YJ. Risk factors for readmission in schizophrenia patients following involuntary admission. PLoS One 2017; 12:e0186768. [PMID: 29073180 PMCID: PMC5658080 DOI: 10.1371/journal.pone.0186768] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2017] [Accepted: 10/07/2017] [Indexed: 11/21/2022] Open
Abstract
Background Individuals with schizophrenia who are involuntarily admitted may have poorer prognosis, including higher readmission rates, than those voluntarily admitted. However, little is known about the risk factors for readmission in those schizophrenia patients who are involuntarily admitted. Aims We aim to explore the risk factors for readmission in this population. Method We enrolled 138 schizophrenia patients with involuntary admission from July 2008 to June 2013 and followed those patients for readmission outcomes at 3 months and at 1 year. Results The one-year and 3-months readmission rates were 33.3% and 15.2%, respectively. Unmarried status (adjusted odds ratio (aOR) = 6.28, 95% CI: 1.48–26.62), previous history of involuntary admission (aOR = 4.08, 95% CI: 1.19–14.02), longer involuntary admission days (aOR = 1.04, 95% CI: 1.01–1.07) and shorter total admission days (aOR = 1.03, 95% CI: 1.01–1.05) were associated with increased risk for 1-year readmission. Younger age (aOR = 1.10, 95% CI 1.02–1.18) was associated with increased risk for 3-months readmission. Conclusions Unmarried status, prior history of involuntary admission, longer involuntary admission days and shorter total admission days were associated with increased risk for 1-year readmission. Healthcare providers may need to focus on patients with these risk factors to reduce subsequent readmissions.
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Affiliation(s)
- Yu-Yuan Hung
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Hung-Yu Chan
- Taoyuan Psychiatric Center, Ministry of Health and Welfare, Taoyuan, Taiwan
- Department of Psychiatry, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yi-Ju Pan
- Department of Psychiatry, Far Eastern Memorial Hospital, New Taipei City, Taiwan
- School of Medicine, National Yang-Ming University, Taipei, Taiwan
- * E-mail:
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The use of psychiatric services by young adults who came to Sweden as teenage refugees: a national cohort study. Epidemiol Psychiatr Sci 2017; 26:526-534. [PMID: 27353562 PMCID: PMC6999002 DOI: 10.1017/s2045796016000445] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
AIMS To investigate the patterns of use of different forms of psychiatric care in refugees who settled in Sweden as teenagers. METHOD Cox proportional hazards models were used to estimate the use of different forms of psychiatric care from 2009 to 2012 in a population of 35 457 refugees, aged from 20 to 36, who had settled in Sweden as teenagers between 1989 and 2004. These findings were compared with 1.26 million peers from the same birth cohorts in the general Swedish population. RESULTS Unaccompanied and accompanied refugees were more likely to experience compulsory admission to a psychiatric hospital compared with the native Swedish population, with hazard ratios (HRs) of 2.76 (1.86-4.10) and 1.89 (1.53-2.34), respectively, as well as psychiatric inpatient care, with HRs of 1.62 (1.34-1.94) and 1.37 (1.25-1.50). Outpatient care visits by the young refugees were similar to the native Swedish population. The longer the refugees had residency in Sweden, the more they used outpatient psychiatric care. Refugees born in the Horn of Africa and Iran were most likely to undergo compulsory admission, with HRs of 3.98 (2.12-7.46) and 3.07 (1.52-6.19), respectively. They were also the groups who were most likely to receive inpatient care, with HRs of 1.55 (1.17-2.06) and 1.84 (1.37-2.47), respectively. Our results also indicated that the use of psychiatric care services increased with the level of education in the refugee population, while the opposite was true for the native Swedish population. In fact, the risks of compulsory admissions were particularly higher among refugees who had received a secondary education, compared with native Swedish residents, with HRs of 4.72 (3.06-7.29) for unaccompanied refugees and 2.04 (1.51-2.73) for accompanied refugees. CONCLUSIONS Young refugees received more psychiatric inpatient care than the native Swedish population, with the highest rates seen in refugees who were not accompanied by their parents. The discrepancy between the use of inpatient and outpatient care by young refugees suggests that there are barriers to outpatient care, but we did note that living in Sweden longer increased the use of outpatient services. Further research is needed to clarify the role that education levels among Sweden's refugee populations have on their mental health and health-seeking behaviour.
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Stylianidis S, Peppou LE, Drakonakis N, Douzenis A, Panagou A, Tsikou K, Pantazi A, Rizavas Y, Saraceno B. Mental health care in Athens: Are compulsory admissions in Greece a one-way road? INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2017; 52:28-34. [PMID: 28431745 DOI: 10.1016/j.ijlp.2017.04.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 03/08/2017] [Accepted: 04/04/2017] [Indexed: 06/07/2023]
Abstract
Involuntary hospitalization has long been a contentious issue worldwide. In Greece, the frequency of compulsory admissions is assumed to be alarmingly high; however, no study has systematically investigated this issue. In line with this, the present study aims to estimate the frequency of compulsory admissions in a psychiatric hospital and to explore its underpinnings. All individuals who were admitted to the Psychiatric Hospital of Attica during June-October 2011 were included into the study. Information about their socio-demographic and clinical characteristics as well as their previous contact with mental health services was obtained from interviewing the patient and his/her physician. Furthermore, information about the initiation of the process of compulsory admission as well as patient's referral upon discharge was retrieved from patients' administrative record. Out of the 946 admissions 57.4% were involuntary. A diagnosis of unipolar depression, high social support and previous contact with community mental health services were found to yield a protective effect against involuntary hospitalization. Moreover, 69.8% of civil detentions were instigated by close relatives and 30.2% ex officio. These two groups differed in patients' social support levels and in medication discontinuation being the reason for initiation of the process. Lastly, only 13.8% of patients were referred to community mental health services at discharge. Our findings suggest that civil detentions are deeply entrenched in clinical routine in Greece. Moreover, poor coordination among services and relatives' burden seem to contribute substantially to the elevated rates.
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Affiliation(s)
- Stelios Stylianidis
- Association for Regional Development and Mental Health (EPAPSY), Athens, Greece; Panteion University of Social Sciences, Athens, Greece.
| | | | | | - Athanasios Douzenis
- 2nd Department of Psychiatry, University of Athens, Attikon Hospital, Athens, Greece
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Abstract
Patients who are subject to compulsory care constitute a substantial proportion of the work-load of mental health professionals, particularly psychiatric nurses. This article examines the traditional ‘beneficence-autonomy’ approach to ethics in compulsory psychiatric care and evaluates it against the reality of daily practice. Risk to the public has always been an important but often unacknowledged consideration. Inequalities exist among ethnic and socio-economic groups and there is a lack of agreement on what constitutes mental disorder. Two major changes in compulsory psychiatric care - community orders and care for patients with untreatable severe personality disorders - further challenge the traditional ethical approach. There are also important human rights implications. The simple patient-health professional relationship no longer provides an adequate framework for mental health professionals on which to base their ethical decisions. The public and organizations may have different perspectives and their interests are becoming increasingly important. Mental health professionals, particularly psychiatric nurses, may face ethical dilemmas because of these different perspectives.
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Affiliation(s)
- Wai-Ching Leung
- Public Health Medicine, Health Policy and Practice, Elizabeth Fry Building, University of East Anglia, Norwich NR4 7TJ, UK.
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Curley A, Agada E, Emechebe A, Anamdi C, Ng XT, Duffy R, Kelly BD. Exploring and explaining involuntary care: The relationship between psychiatric admission status, gender and other demographic and clinical variables. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2016; 47:53-59. [PMID: 27033975 DOI: 10.1016/j.ijlp.2016.02.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Involuntary admission and treatment are features of psychiatric care in many countries, but the relationship between involuntary status and gender (among other factors) is not clear. We examined demographic and diagnostic factors associated with involuntary admission in a general adult psychiatry service in a deprived area of Dublin's north inner-city over a 7-year period (2008 to 2014 inclusive). Over this period, there were 1099 admissions, yielding an annual admission rate of 504.8 admissions per 100,000 population per year. When adjusted for deprivation, this rate (387.7) was lower than the national rate (413.9). Consistent with other inner-city areas in Dublin, 14.1% of admissions were involuntary, yielding an involuntary admission rate of 71.2 per 100,000 population per year (deprivation-adjusted rate: 54.8), which is higher than the national rate (39.4). After controlling for age, occupation, marital status and diagnosis, the only independent predictors of admission status were place of origin (p<0.001) and male gender (p=0.001). These findings are consistent with studies showing associations between male gender and involuntary status in the United States, New Zealand, Netherlands, Norway, Belgium, France, and Luxembourg. In contrast, female gender is associated with involuntary status in Switzerland, Brazil, and China. These cross-national differences are likely related to differing legal traditions and different criteria for involuntary admission, possibly related to varying emphases placed on "dangerousness" as a mandatory criterion for involuntary hospitalization. This merits further, cross-national study.
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Affiliation(s)
- Aoife Curley
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Emmanuel Agada
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Afam Emechebe
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Chike Anamdi
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Xiao Ting Ng
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Richard Duffy
- Department of Adult Psychiatry, UCD School of Medicine and Medical Science, Mater Misericordiae University Hospital, University College Dublin, 62/63 Eccles Street, Dublin, 7, Ireland.
| | - Brendan D Kelly
- Department of Psychiatry, Trinity Centre for Health Sciences, Tallaght Hospital, Trinity College Dublin, Dublin 24, Ireland.
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van der Post LFM, Beekman ATF, Peen J, Zoeteman J, Twisk JWR, Dekker JJM. Patterns of Care Consumption after Compulsory Admission: A Five-Year Follow-Up to the Amsterdam Study of Acute Psychiatry VIII. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2016. [DOI: 10.1080/00207411.2016.1156942] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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The Low Proportion and Associated Factors of Involuntary Admission in the Psychiatric Emergency Service in Taiwan. PLoS One 2015; 10:e0129204. [PMID: 26046529 PMCID: PMC4457903 DOI: 10.1371/journal.pone.0129204] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2014] [Accepted: 05/07/2015] [Indexed: 11/19/2022] Open
Abstract
Background The involuntary admission regulated under the Mental Health Act has become an increasingly important issue in the developed countries in recent years. Most studies about the distribution and associated factors of involuntary admission were carried out in the western countries; however, the results may vary in different areas with different legal and socio-cultural backgrounds. Aims The aim of this study was to investigate the proportion and associated factors of involuntary admission in a psychiatric emergency service in Taiwan. Methods The study cohort included patients admitted from a psychiatric emergency service over a two-year period. Demographic, psychiatric emergency service utilization, and clinical variables were compared between those who were voluntarily and involuntarily admitted to explore the associated factors of involuntary admission. Results Among 2,777 admitted patients, 110 (4.0%) were involuntarily admitted. Police referrals and presenting problems as violence assessed by psychiatric nurses were found to be associated with involuntary admission. These patients were more likely to be involuntarily admitted during the night shift and stayed longer in the psychiatric emergency service. Conclusions The proportion of involuntary admissions in Taiwan was in the lower range when compared to Western countries. Dangerous conditions evaluated by the psychiatric nurses and police rather than diagnosis made by the psychiatrists were related factors of involuntary admission. As it spent more time to admit involuntary patients, it was suggested that multidisciplinary professionals should be included in and educated for during the process of involuntary admission.
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Kelly BD, Emechebe A, Anamdi C, Duffy R, Murphy N, Rock C. Custody, care and country of origin: demographic and diagnostic admission statistics at an inner-city adult psychiatry unit. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2015; 38:1-7. [PMID: 25634112 DOI: 10.1016/j.ijlp.2015.01.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Involuntary detention is a feature of psychiatric care in many countries. We previously reported an involuntary admission rate of 67.7 per 100,000 population per year in inner-city Dublin (January 2008-December 2010), which was higher than Ireland's national rate (38.5). We also found that the proportion of admissions that was involuntary was higher among individuals born outside Ireland (33.9%) compared to those from Ireland (12.0%), apparently owing to increased diagnoses of schizophrenia in the former group. In the present study (January 2011-June 2013) we again found that the proportion of admissions that was involuntary was higher among individuals from outside Ireland (32.5%) compared to individuals from Ireland (9.9%) (p<0.001), but this is primarily attributable to a lower rate of voluntary admission among individuals born outside Ireland (206.1 voluntary admissions per 100,000 population per year; deprivation-adjusted rate: 158.5) compared to individuals from Ireland (775.1; deprivation-adjusted rate: 596.2). Overall, admission rates in our deprived, inner-city catchment area remain higher than national rates and this may be attributable to differential effects of Ireland's recent economic problems on different areas within Ireland. The relatively low rate of voluntary admission among individuals born outside Ireland may be attributable to different patterns of help-seeking which mental health services in Ireland need to take into account in future service-planning. Other jurisdictions could also usefully focus attention not just on rates on involuntary admission among individuals born elsewhere, but also rates of voluntary admission which may provide useful insights for service-planning and delivery.
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Affiliation(s)
- Brendan D Kelly
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Afam Emechebe
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Chike Anamdi
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Richard Duffy
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
| | - Niamh Murphy
- School of Medicine, Clinical Sciences Institute, National University of Ireland Galway, Newcastle Road, Galway, Ireland.
| | - Catherine Rock
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
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La décision d’hospitalisation sans consentement aux urgences : approche dimensionnelle ou catégorielle ? Encephale 2014; 40:247-54. [DOI: 10.1016/j.encep.2013.03.009] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 03/21/2013] [Indexed: 11/18/2022]
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van der Post LF, Peen J, Visch I, Mulder CL, Beekman AT, Dekker JJ. Patient perspectives and the risk of compulsory admission: the Amsterdam Study of Acute Psychiatry V. Int J Soc Psychiatry 2014; 60:125-33. [PMID: 23333906 DOI: 10.1177/0020764012470234] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Compulsory admission to a psychiatric hospital is associated with a three- to fourfold increase in the risk of another compulsory admission. Given the rising numbers of civil detentions in The Netherlands and other European countries, it is important to understand the mechanism behind this association. Our aim is to study the links between opinions about prior psychiatric treatment, insight, service engagement and the risk of (new) civil detentions. METHODS We took a random sample of 252 from the 2,682 patients consecutively coming into contact with two psychiatric emergency teams in Amsterdam between September 2004 and September 2006. We recorded socio-demographic and clinical characteristics, and information about prior involuntary admissions. We interviewed the patients using the Verona Service Satisfaction Scale (Verona-EU), the Birchwood Insight Scale and the Service Engagement Scale. During a two-year follow-up period we noted their use of mental health care facilities. RESULTS Patients with a satisfactory score on the Verona-EU had significantly lower odds for civil detentions during follow-up compared to patients with a dissatisfactory score on this scale (OR = 0.3). Level of insight did not influence the risk of detention during follow-up. Furthermore, of the 131 patients admitted involuntarily the year before, one-third looked back on their involuntary admission with unambiguous satisfaction. CONCLUSION More satisfaction with prior treatment seems to reduce the risk of civil detention remarkably. Low levels of satisfaction seem to be mainly dependent on a history of previous involuntary admission. These findings seem to open up a new perspective for diminishing the risk of (new) civil detention by trying to enhance satisfaction with treatment, especially for patients under detention.
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Smith D, Roche E, O’Loughlin K, Brennan D, Madigan K, Lyne J, Feeney L, O’Donoghue B. Satisfaction with services following voluntary and involuntary admission. J Ment Health 2014; 23:38-45. [DOI: 10.3109/09638237.2013.841864] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Kisely S, Preston N, Xiao J, Lawrence D, Louise S, Crowe E, Segal S. An eleven-year evaluation of the effect of community treatment orders on changes in mental health service use. J Psychiatr Res 2013; 47:650-6. [PMID: 23415453 DOI: 10.1016/j.jpsychires.2013.01.010] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 01/15/2013] [Accepted: 01/15/2013] [Indexed: 10/27/2022]
Abstract
Many studies of compulsory community treatment have assessed their effect early on after the implementation of legislation. Although compulsory community treatment may not prevent readmission to hospital, there is evidence of an effect on length of stay before and after the intervention when compared to controls. This paper examines whether outcomes change as clinicians gain experience in the use of community treatment orders (CTOs). Cases and controls from three linked Western Australian databases were matched on age, sex, diagnosis and time of hospital discharge or community placement. We compared changes in bed-days and outpatient visits of CTO cases and controls using multivariate analyses to further control for confounders. We identified 2958 CTO cases and controls from November 1997 to December 2008 (total n = 5916). The average age was 37 years and 64% were male. Schizophrenia and other non-affective psychoses were the commonest diagnoses (73%). CTO placement was associated with a mean decrease of 5 bed-days from before the order when compared to controls (B = -5.23, s.e. = 1.60, t = -3.26, p < 0.001). There was an increase of 8 days in outpatient contacts (B = 8.31, s.e. = 1.17, t = 7.11, p < 0.001). There was little change in CTO use and outcomes over the 11 years. Compared to controls, CTOs may therefore reduce lengths of stay from before placement on the order. They also increase outpatient contacts. This study illustrates the importance of selecting an outcome that directly addresses the objective of the intervention.
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Affiliation(s)
- Steve Kisely
- School of Population Health, University of Queensland, Herston, Australia.
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Montemagni C, Frieri T, Villari V, Rocca P. Compulsory admissions of emergency psychiatric inpatients in Turin: the role of diagnosis. Prog Neuropsychopharmacol Biol Psychiatry 2012; 39:288-94. [PMID: 22765924 DOI: 10.1016/j.pnpbp.2012.06.020] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2012] [Revised: 06/20/2012] [Accepted: 06/26/2012] [Indexed: 11/16/2022]
Abstract
Many studies have found high levels of compulsory admission (CA) among non-affective psychoses. Aims of the present study were to investigate whether there was a mere association between diagnosis and CA in a cohort of 848 patients referring to a Psychiatric Emergency Service in a catchment area in Turin during a 2-year period, independent of socio-demographic features, psychiatric history, and clinical status. Diagnosis as a risk factor for CA was assessed constructing a logistic regression model, using the following steps: first, assessing the association between diagnoses and CA, without controlling for confounding factors; second, entering socio-demographic factors; third, entering socio-demographic factors and psychiatric history; and fourth, entering socio-demographic, psychiatric history, and aspects of clinical presentation into the model. At step 1 patients with Non Affective Psychoses, Mania and Personality Disorders had a significantly higher CA risk, compared to patients with Depressive Disorders. At step 4 diagnosis was no longer associated with CA. History of CAs within past 5years and Brief Psychiatric Rating Scale (BPRS) hostile-suspiciousness were positively associated with CA. Length of illness, history of previous suicidal attempts and BPRS anxiety-depression were negatively associated with CA. Overall, the percentage of correctly predicted cases was 39.8%. The remaining 60% can be explained by inherent variability or unknown, lurking variables. Finally, the study was carried out at a single facility. Much of the increased CA likelihood in diagnostic categories might be attributable to specific symptom patterns, not to patients' severity of illness or diagnosis per se.
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Affiliation(s)
- Cristiana Montemagni
- Department of Neuroscience, Psychiatric Section, University of Turin, Turin, Italy
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Kisely S, Preston N, Xiao J, Lawrence D, Louise S, Crowe E. Reducing all-cause mortality among patients with psychiatric disorders: a population-based study. CMAJ 2012; 185:E50-6. [PMID: 23148054 DOI: 10.1503/cmaj.121077] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Among patients with psychiatric disorders, there are 10 times as many preventable deaths from physical disorders as there are from suicide. We investigated whether compulsory community treatment, such as community treatment orders, could reduce all-cause mortality among patients with psychiatric disorders. METHODS We conducted a population-based survival analysis of an inception cohort using record linking. The study period extended from November 1997 to December 2008. The cohort included patients from all community-based and inpatient psychiatric services in Western Australia (state population 1.8 million). We used a 2-stage design of matching and Cox regression to adjust for demographic characteristics, previous use of health services, diagnosis and length of psychiatric history. We collected data on successive cohorts for each year for which community treatment orders were used to measure changes in numbers of patients, their characteristics and outcomes. Our primary outcome was 2-year all-cause mortality. Our secondary outcomes were 1-and 3-year all-cause mortality. RESULTS The study population included 2958 patients with community treatment orders (cases) and 2958 matched controls (i.e., patients with psychiatric disorders who had not received a community treatment order). The average age for cases and controls was 36.7 years, and 63.7% (3771) of participants were men. Schizophrenia and other nonaffective psychoses were the most common diagnoses (73.4%) among participants. A total of 492 patients (8.3%) died during the study. Cox regression showed that, compared with controls, patients with community treatment orders had significantly lower all-cause mortality at 1, 2 and 3 years, with an adjusted hazard ratio of 0.62 (95% confidence interval 0.45-0.86) at 2 years. The greatest effect was on death from physical illnesses such as cancer, cardiovascular disease or diseases of the central nervous system. This association disappeared when we adjusted for increased outpatient and community contacts with psychiatric services. INTERPRETATION Community treatment orders might reduce mortality among patients with psychiatric disorders. This may be partly explained by increased contact with health services in the community. However, the effects of uncontrolled confounders cannot be excluded.
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Affiliation(s)
- Steve Kisely
- Department of Psychiatry, Community Health and Epidemiology, Dalhousie University, Halifax, NS, Australia.
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Ng XT, Kelly BD. Voluntary and involuntary care: three-year study of demographic and diagnostic admission statistics at an inner-city adult psychiatry unit. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2012; 35:317-326. [PMID: 22560406 DOI: 10.1016/j.ijlp.2012.04.008] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Individuals with mental disorders can, under specific circumstances, be detained and treated against their wishes. In 2009, there were 1633 involuntary admissions in Ireland, accounting for 8.1% of all psychiatric admissions. We examined demographic and diagnostic factors associated with involuntary admission in a general adult psychiatry service in Dublin's north inner-city over a retrospective three-year period. The overall admission rate was 450.5 admissions per 100,000 population per year (deprivation-adjusted rate: 345.7), which is lower than the national rate (476.3). The involuntary admission rate was 67.7 (deprivation-adjusted rate: 51.9), which is higher than the national rate (38.5). Fifteen per cent of admissions were involuntary (for all or part of the admission), which is higher than the national proportion (8.1%) but the same as that reported in another inner-city psychiatry service (15.7%). The proportion of admissions that was involuntary was higher amongst individuals from outside Ireland (33.9%) compared to those from Ireland (12.0%) (p<0.001). Country of origin was, however, related to diagnosis: 53.2% of admissions of individuals from outside Ireland were with schizophrenia, compared to 18.5% of admissions of individuals from Ireland (p<0.001). Diagnosis was, in turn, related to admission status: 37.5% of admissions with schizophrenia were involuntary compared to 15% overall (p<0.001). On multi-variable testing, diagnosis was the only independent predictor of admission status (p=0.01) (R(2)=35.2%); country of origin was not an independent predictor of admission status. Deprivation accounts for part, but not all, of the high rate of involuntary admission in Dublin's inner-city. Diagnosis accounts for one third of the variance in admission status between individuals. Further study is required to determine what factors account for the remaining two thirds (e.g. symptoms, insight) and to clarify better the relationships between admission status, diagnosis and country of origin. There is a strong need for enhanced focus on the mental health needs of individuals from outside of Ireland, especially in Dublin's north inner-city.
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Affiliation(s)
- Xiao Ting Ng
- Department of Adult Psychiatry, University College Dublin, Mater Misericordiae University Hospital, 62/63 Eccles Street, Dublin 7, Ireland.
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Iversen VC, Berg JE, Småvik R, Vaaler AE. Clinical differences between immigrants voluntarily and involuntarily admitted to acute psychiatric units: a 3-year prospective study. J Psychiatr Ment Health Nurs 2011; 18:671-6. [PMID: 21896109 DOI: 10.1111/j.1365-2850.2011.01718.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Involuntary psychiatric admissions are widespread among patients with an immigrant background. According to a study in Norway, involuntary admissions are about 75% of admissions among immigrants compared to roughly 50% among ethnic Norwegians. The aim of the present study was to compare clinical and demographic characteristics of immigrant patients with involuntary or voluntary admissions to two acute psychiatric units. A 3-year prospective study of 94 immigrant patients involuntarily and voluntarily admitted to acute psychiatric units was carried out. Sixty-two patients (66.0%) were voluntarily and 30 (31.9%) involuntarily admitted. Involuntary admissions were significantly higher among men (22, 73.3%) compared to women (8, 26.7%; χ(2) = 4.507, d.f. = 1, P= 0.03). The mean length of stay for voluntary and involuntary patients were 7.8 (SD = 6.6) and 21.6 (SD = 27.3; t=-2.7, d.f. = 88, P= 0.01). Patients diagnosed with schizophrenia and psychotic disorder were more often admitted involuntarily (63.0%; χ(2) = 17.83, P= 0.001). This study confirms that immigrant patients diagnosed with psychotic disorders are more often involuntarily than voluntarily admitted. Comparing the clinical and demographic characteristics of immigrants helps identify the reasons behind involuntary admissions and might improve efforts towards reducing such admissions in the future.
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Affiliation(s)
- V C Iversen
- Department of Neuroscience, Norwegian University of Science and Technology, Trondheim, Norway.
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Lay B, Nordt C, Rössler W. Variation in use of coercive measures in psychiatric hospitals. Eur Psychiatry 2011; 26:244-51. [PMID: 21296560 DOI: 10.1016/j.eurpsy.2010.11.007] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2010] [Revised: 11/12/2010] [Accepted: 11/15/2010] [Indexed: 01/12/2023] Open
Abstract
PURPOSE The use of coercive measures in psychiatry is still poorly understood. Most empirical research has been limited to compulsory admission and to risk factors on an individual patient level. This study addresses three coercive measures and the role of predictive factors at both patient and institutional levels. METHODS Using the central psychiatric register that covers all psychiatric hospitals in Canton Zurich (1.3 million people), Switzerland, we traced all inpatients in 2007 aged 18-70 (n = 9698). We used GEE models to analyse variation in rates between psychiatric hospitals. RESULTS Overall, we found quotas of 24.8% involuntary admissions, 6.4% seclusion/restraint and 4.2% coerced medication. Results suggest that the kind and severity of mental illness are the most important risk factors for being subjected to any form of coercion. Variation across the six psychiatric hospitals was high, even after accounting for risk factors on the patient level suggesting that centre effects are an important source of variability. However, effects of the hospital characteristics 'size of the hospital', 'length of inpatient stay', and 'work load of the nursing staff' were only weak ('bed occupancy rate' was not statistically significant). CONCLUSION The significant variation in use of coercive measures across psychiatric hospitals needs further study.
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Affiliation(s)
- B Lay
- Psychiatric University Hospital Zurich, Research Unit for Clinical and Social Psychiatry, Militärstrasse 8, PO Box 1930, 8021 Zurich, Switzerland.
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Predictors of compulsory admission in schizophrenia-spectrum patients: excitement, insight, emotion perception. Prog Neuropsychopharmacol Biol Psychiatry 2011; 35:137-45. [PMID: 20951758 DOI: 10.1016/j.pnpbp.2010.10.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2010] [Revised: 10/01/2010] [Accepted: 10/07/2010] [Indexed: 11/22/2022]
Abstract
PURPOSE We explored socio-demographic and clinical variables associated with compulsory admissions (CA) compared with voluntary admissions in schizophrenia-spectrum patients; moreover, we investigated the ability of excitement, emotion perception, and lack of insight to predict CA. METHODS 119 consecutive schizophrenia-spectrum patients admitted to the Servizio Psichiatrico di Diagnosi e Cura (SPDC = PES = psychiatric emergency service) of the Department of Neuroscience and Mental Health-San Giovanni Battista Hospital of Turin in the period between December 2007 and December 2009 were enrolled in the study. A backward stepwise logistic regression was used to test factors contributing to CA. RESULTS CA rate in our sample was 28.5%. Previous CAs, drop-out, severity of illness, positive symptoms, excitement, emotion perception, and insight were significantly different in CA patients compared to voluntary ones. After backward selection of variables, three variables predicted CA in our sample: excitement, impaired emotion perception and lesser insight. Finally, the effect of excitement on CA status seemed partially mediated by emotion perception, the prediction model accounting for 53.8% of the variance of CA status. Conversely, insight seemed not to be a mediator of excitement on CA. IMPLICATIONS Understanding CA patterns in special populations represents a first step towards improving clinical decision-making and developing appropriate interventions and service-provision.
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Involuntary commitment and detainment in adolescent psychiatric inpatient care. Soc Psychiatry Psychiatr Epidemiol 2010; 45:785-93. [PMID: 19690788 DOI: 10.1007/s00127-009-0116-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 07/31/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To evaluate whether adolescents committed to psychiatric inpatient care are the most disturbed, and whether psychosocial factors other than psychiatric symptoms are associated with commitment to and detainment in psychiatric care among adolescents. MATERIALS AND METHODS The case histories of 187 13- to 17-year-old adolescents consecutively admitted to the study clinic were scrutinized with the help of a structured data collection form. Psychiatric, demographic and family-related characteristics of those referred involuntarily (n = 93) and voluntarily (n = 94), and those detained involuntarily (n = 42) and treated on a voluntary basis (n = 145) were compared. RESULTS Involuntary referral and involuntary detainment were associated with psychotic symptoms, temper tantrums and breaking property, involuntary referral also with violent and hostile behaviours and suicidal ideation and talk. They were not associated to family adversities, previous treatment history or sociodemographic factors. The risk for being committed when presenting with aggressive behaviours was greater in girls. CONCLUSION Involuntary referral and detainment in adolescents is associated with symptom severity, and not with aspects of the adolescent's living conditions. This is in agreement with the legislation. Gender bias resulting in girls' greater risk of being involuntarily committed if displaying aggressive behaviours may be an ethical and legal problem.
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van der Post LFM, Dekker JJM, Jonkers JFJ, Beekman ATF, Mulder CL, de Haan L, Mulder WG, Schoevers RA. Crisis intervention and acute psychiatry in Amsterdam, 20 years of change: a historical comparison of consultations in 1983 and 2004-2005. Int J Soc Psychiatry 2010; 56:348-58. [PMID: 19617280 DOI: 10.1177/0020764008098839] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM There has been a striking increase in the number of compulsory admission proceedings in the Netherlands since 1992, to such an extent that treatment in Amsterdam's psychiatric clinics is in danger of being dominated by coercive treatment. Our aim was to establish a picture of the changes in emergency psychiatry that have contributed to the increase in the number of acute compulsory admissions. METHODS A cohort (N = 460) of psychiatric emergency consultations with the city crisis service in 1983 was compared with a similar cohort (N = 436) in 2004-2005. The study focused on the following variables: patient characteristics, crisis-service procedures and consultation outcomes. RESULTS Compared with 1983, there are now more services involved in crisis support in the public domain for psychiatric patients. The number of patients referred by the police has risen from 29% to 63%. In 1983, all consultations took place where the patients were located; at present, 60% take place at the crisis service premises. The number of psychotic patients in the cohort has increased from 52.0% and 63.3 %. There has been an increase in the proportion of compulsory admissions and a sharp decrease in the proportion of voluntary admissions from 61% to 28% of all admissions. Overall, the percentage of consultations leading to a psychiatric admission has fallen from 42% to 27%. CONCLUSION The front-line outreach service of 1983 has changed into a specialist psychiatric emergency department with a less pronounced outreach component. Voluntary admissions to psychiatric hospitals have almost disappeared as a feature of the crisis service.
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Lorant V, Depuydt C, Gillain B, Guillet A, Dubois V. Involuntary commitment in psychiatric care: what drives the decision? Soc Psychiatry Psychiatr Epidemiol 2007; 42:360-5. [PMID: 17396204 DOI: 10.1007/s00127-007-0175-2] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/16/2007] [Indexed: 10/23/2022]
Abstract
BACKGROUND Psychiatric commitment laws have been reformed in many European countries. We assessed the relative importance of the different legal criteria in explaining involuntary commitment under the Belgian Mental Health Act of 1990. METHOD Psychiatric assessments were requested for 346 patients living in Brussels who were randomly selected from a larger group and were being considered for involuntary commitment. A retrospective study of these patients' files was carried out. RESULTS More than half of the requests for involuntary commitment were turned down. The lack of a less restrictive alternative form of care was the criterion most crucial in decisions in favour of commitment. Alternative forms of care were more likely to be unavailable for psychotic individuals, foreigners, and patients not living in a private household. CONCLUSION Involuntary commitment is mainly due to the inability of the mental health care system to provide more demanding patients with alternative forms of care.
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Affiliation(s)
- Vincent Lorant
- Public Health School, Faculty of Medicine, Université Catholique de Louvain, Louvain, Belgium
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Siponen U, Välimäki M, Kaivosoja M, Marttunen M, Kaltiala-Heino R. Increase in involuntary psychiatric treatment and child welfare placements in Finland 1996-2003. A nationwide register study. Soc Psychiatry Psychiatr Epidemiol 2007; 42:146-52. [PMID: 17235444 DOI: 10.1007/s00127-006-0148-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2006] [Indexed: 10/23/2022]
Abstract
BACKGROUND Emotional and behavioural problems are common in young people and mental health problems are frequently intertwined with social problems. Both involuntary psychiatric treatment and taking into care may be used in order to manage youth behavioural problems. Compulsory interventions always endanger violating basic civil rights and therefore careful monitoring of them is warranted. AIM The aim of this study was to evaluate trends in Finland in involuntary psychiatric inpatient treatment and taking into care 12- to 17-year-old adolescents from the mid-1990s to the early 2000s. METHOD A nationally representative retrospective register study of the period 1996-2003 using the hospital discharge register and child welfare register in Finland. RESULTS Both types of compulsory interventions increased vastly during the study period. The numbers of involuntary psychiatric treatment periods and child welfare placements of adolescents varied considerably in relation to each other, and across different regions of the country. CONCLUSIONS As there is no evidence of a vast increase in mental disorders or serious behavioural problems in young people, there is an obvious need for further research on reasons of the significant increase in the use of coercion and for the wide regional variation. Possible explanations discussed are different service structures and treatment cultures.
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Affiliation(s)
- Ulla Siponen
- Dept. of Nursing Science, University of Turku, Turku, Finland.
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Kaltiala-Heino R, Fröjd S. Severe mental disorder as a basic commitment criterion for minors. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2007; 30:81-94. [PMID: 17150252 DOI: 10.1016/j.ijlp.2006.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/22/2005] [Revised: 10/21/2005] [Accepted: 04/06/2006] [Indexed: 05/12/2023]
Abstract
Since 1991, commitment to involuntary psychiatric care has been allowed in Finland for minors in broader terms than for adults. While in adults mental illness has to be diagnosable before involuntary treatment can be imposed, minors can be committed to and detained in involuntary psychiatric treatment if they suffer from "severe mental disorders", and fulfil the further commitment criteria defined in the Mental Health Act. The first years of the new mental health legislation showed an increase in involuntary treatment of minors in Finland. Concerns were raised about the imprecise nature of the commitment criterion "severe mental illness". This study set out to find out whether Finnish child and adolescent psychiatrists are in agreement on how to define severe mental illness and whether their interpretations are sufficiently similar to ensure the equality of minors in commitment to psychiatric care as prescribed by the Mental Health Act. Semi-structured, reflexive dyadic interviews were carried out with 44 psychiatrists working with children and adolescents. The data was analysed using qualitative content analysis. There was general agreement about what constitutes a "severe mental disorder" justifying the involuntary psychiatric treatment of minors. The child and adolescent psychiatrists were of the opinion that involuntary treatment of minors should not be tied to specific diagnostic categories. Which disorders are severe enough to justify commitment should rather be considered through developmental and functional impairment and interactions between a minor and her/his environment.
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Affiliation(s)
- Riittakerttu Kaltiala-Heino
- Psychiatric Treatment and Research Unit for Adolescent Intensive Care (EVA), Tampere University Hospital Pitkäniemi, 33380 Pitkäniemi, Finland.
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Bauer A, Rosca P, Grinshpoon A, Khawaled R, Mester R, Yoffe R, Ponizovsky AM. Trends in involuntary psychiatric hospitalization in Israel 1991-2000. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2007; 30:60-70. [PMID: 17141875 DOI: 10.1016/j.ijlp.2006.02.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2005] [Revised: 11/21/2005] [Accepted: 02/24/2006] [Indexed: 05/12/2023]
Abstract
BACKGROUND Though information about involuntary psychiatric hospitalizations (IPH) is crucial for the planning of Israel's National Mental Health Care Policy, very few studies have been carried out to date on this subject. AIMS To identify trends in first IPH to all inpatient psychiatric settings in Israel. METHOD The sample included all admissions of adults (18 years and older) over the ten-year period, 1991-2000, according to the registration of such admissions in the National Psychiatric Case Registry. RESULTS A 2.4-fold increase was found in first IPH over the decade studied. The typical profile of the involuntarily admitted patient was that of a native-born Jewish male, aged 18-24 or 65 and older, single, with less than 8 years of education, and with a diagnosis of schizophrenia or delusional psychosis. CONCLUSIONS These findings suggest the need for improving the interfaces between hospital and community services, and for preparing specific guidelines to extend the use of involuntary ambulatory treatment orders. Further study is needed to explore the respective roles of involuntary inpatient and outpatient treatment.
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Affiliation(s)
- Arie Bauer
- Forensic Psychiatry Unit, Mental Health Services, Ministry of Health, Jerusalem, Israel
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Steinert T, Lepping P, Baranyai R, Hoffmann M, Leherr H. Compulsory admission and treatment in schizophrenia: a study of ethical attitudes in four European countries. Soc Psychiatry Psychiatr Epidemiol 2005; 40:635-41. [PMID: 16133746 DOI: 10.1007/s00127-005-0929-7] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2005] [Accepted: 03/05/2005] [Indexed: 10/25/2022]
Abstract
This study was conducted to compare attitudes of psychiatrists, other professionals, and laypeople towards compulsory admission and treatment of patients with schizophrenia in different European countries. Three case reports of patients with schizophrenia were presented to N=1,737 persons: 235 in England, 622 in Germany, 319 in Hungary, and 561 in Switzerland; 298 were psychiatrists, 687 other psychiatric or medical professionals, and 752 laypeople. The case reports presented typical clinical situations with refusal of consent to treatment (first episode and social withdrawal, recurrent episode and moderate danger to others and patient with multiple episodes and severe self-neglect). The participants were asked whether they would agree with compulsory admission and compulsory neuroleptic treatment. The rates of agreement varied between 50.8 and 92.1% across countries and between 41.1 and 93.6% across the different professional groups. In all countries, psychologists and social workers supported compulsory procedures significantly less than the psychiatrists who were in tune with laypeople and nurses. Country differences were highly significant showing more agreement with compulsion in Hungary and England and less in Germany and Switzerland (odds ratios up to 4.33). Own history of mental illness and having mentally ill relatives had no major impact on the decisions. Evidence suggests that compulsory procedures are based on traditions and personal attitudes to a considerable degree. Further research should provide empirical data and more definite criteria for indications of compulsive measures to achieve a common ethical framework for those critical decisions across Europe.
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Affiliation(s)
- Tilman Steinert
- Centre for Psychiatry Weissenau, Postfach 2044, 88214, Weissenau, Germany.
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Abstract
Schizophrenia is a severe mental disorder characterised by fundamental disturbances in thinking, perception and emotions. More than 100 years of research have not been able to fully resolve the puzzle that schizophrenia represents. Even if schizophrenia is not a very frequent disease, it is among the most burdensome and costly illnesses worldwide. It usually starts in young adulthood. Life expectancy is reduced by approximately 10 years, mostly as a consequence of suicide. Even if the course of the illness today is considered more favourable than it was originally described, it is still only a minority of those affected, who fully recover. The cumulative lifetime risk for men and women is similar, although it is higher for men in the age group younger than 40 years. According to the Global Burden of Disease Study, schizophrenia causes a high degree of disability, which accounts for 1.1% of the total DALYs (disability-adjusted life years) and 2.8% of YLDs (years lived with disability). In the World Health Report [The WHO World Health Report: new understanding, new hope, 2001. Geneva], schizophrenia is listed as the 8th leading cause of DALYs worldwide in the age group 15-44 years. In addition to the direct burden, there is considerable burden on the relatives who care for the sufferers. The treatment goals for the moment are to identify the illness as early as possible, treat the symptoms, provide skills to patients and their families, maintain the improvement over a period of time, prevent relapses and reintegrate the ill persons into the community so that they can lead as normal a life as possible.
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Affiliation(s)
- Wulf Rössler
- Psychiatric University Hospital, Militärstrasse 8, CH-8021 Zurich, Switzerland.
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Cougnard A, Kalmi E, Desage A, Misdrahi D, Abalan F, Brun-Rousseau H, Salmi LR, Verdoux H. Factors influencing compulsory admission in first-admitted subjects with psychosis. Soc Psychiatry Psychiatr Epidemiol 2004; 39:804-9. [PMID: 15669661 DOI: 10.1007/s00127-004-0826-5] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There is a growing body of evidence that patients with early psychosis have undesirable pathways to care, yet few studies have explored the factors related to compulsory admission in patients with psychosis. The aim of the present study was to examine the demographic and clinical factors and pathways to care influencing compulsory admission in first-admitted subjects with psychosis. METHODS Pathways to care, clinical and demographic characteristics, were assessed using multiple sources of information in 86 subjects with psychosis first admitted in two hospitals of South-Western France. Characteristics independently associated with compulsory admission were explored using logistic regressions. RESULTS Nearly two-thirds of the subjects (61.6%) were compulsorily admitted. Compulsory admission was independently predicted by being a male (adjusted OR = 3.2, 95 % CI 1.2-8.6, p = 0.02), having a diagnosis of schizophrenia broadly defined (adjusted OR = 2.8, 95 % CI 1.02-7.4, p = 0.04) and absence of depressive or anxiety symptoms (adjusted OR = 0.05, 95% CI 0.005-0.5, p=0.01). CONCLUSION These results suggest that factors related to the disease itself play an important role in decisions concerning compulsory admission. The high frequency of compulsory admission as the first mode of contact with psychiatric hospital in subjects with psychosis constitutes a major public health issue. Further research on the strategies aimed at avoiding compulsory admission in subjects with incipient psychosis is necessary.
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Affiliation(s)
- Audrey Cougnard
- Equipe Accueil 3676 MP2S, IFR 99 of Public Health, Université Victor Segalen Bordeaux 2, Bordeaux, France
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Xiao J, Preston NJ, Kisely S. What determines compulsory community treatment? A logistic regression analysis using linked mental health and offender databases. Aust N Z J Psychiatry 2004; 38:613-8. [PMID: 15298583 DOI: 10.1080/j.1440-1614.2004.01429.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Western Australia has one of the highest published rates of the use of compulsory treatment orders in the English-speaking world. Differences in patient characteristics, legislation and service setting may explain variations in the reported efficacy of compulsory community treatment. Our objective is to investigate predictors of Community Treatment Orders (CTO) placement in the first year of implementation in Western Australia and see if there were any differences in the type of patients placed on these orders compared to other studies. METHOD A population-based record linkage study of Mental Health and Offender Databases comparing 265 patients on CTOs with a consecutive control group (CCG) of equal number matched on date of discharge from inpatient care or CTO placement. RESULTS Previous health service use, after-care placement, mental disorder history including schizophrenic history, a positive forensic history of violence to others as well as patient's marital status were the significant predictors of CTO placement. CONCLUSIONS Studies of compulsory community treatment appear to be of similar populations. In spite of the comparatively high rate of use, psychiatrists in Western Australia do not appear to be applying community treatment orders to different types of patient compared to elsewhere. We need further research to establish the relative contribution of patient characteristics, legislation and service setting toward the use and outcome of compulsory community treatment.
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Affiliation(s)
- Jianguo Xiao
- Mental Health Directorate, Fremantle Hospital and Health Service, Fremantle, Western Australia, Australia
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Kelly BD, Clarke M, Browne S, McTigue O, Kamali M, Gervin M, Kinsella A, Lane A, Larkin C, O'Callaghan E. Clinical predictors of admission status in first episode schizophrenia. Eur Psychiatry 2004; 19:67-71. [PMID: 15051104 DOI: 10.1016/j.eurpsy.2003.07.009] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2003] [Revised: 07/21/2003] [Accepted: 07/21/2003] [Indexed: 12/21/2022] Open
Abstract
Having a diagnosis of schizophrenia is a risk factor for involuntary admission to psychiatric inpatient care, but we have a limited understanding of why some patients and not others require involuntary admission. We aimed to identify the predictors of involuntary admission in first episode schizophrenia. We used validated instruments to assess clinical and socio-demographic variables in all patients (n = 78) with first episode schizophrenia from a defined geographical area admitted to a Dublin psychiatric hospital over a 4-year period. Involuntary patients (n = 17) could not be distinguished from voluntary patients (n = 61) on the basis of age, gender, living status, marital status, drug abuse or duration of untreated psychosis. Neither positive nor negative symptoms were useful predictors of admission status. Lack of insight was a strong predictor of involuntary status.
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Affiliation(s)
- B D Kelly
- Stanley Research Unit, Cluain Mhuire Family Centre, St. John of God Adult Psychiatric Services, Newtownpark Avenue, Blackrock, Co. Dublin, Ireland
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Kisely SR, Xiao J, Preston NJ. Impact of compulsory community treatment on admission rates: survival analysis using linked mental health and offender databases. Br J Psychiatry 2004; 184:432-8. [PMID: 15123508 DOI: 10.1192/bjp.184.5.432] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND There is controversy as to whether compulsory community treatment for psychiatric patients reduces hospital admission rates. AIMS To examine whether community treatment orders (CTOs) reduce admission rates, using a two-stage design of matching and multivariate analyses to take into account socio-demographic factors, clinical factors, case complexity and previous psychiatric and forensic history. METHOD Survival analysis of CTO cases and controls from three linked Western Australian databases of health service use, involuntary treatment and forensic history. We used two control groups: one matched on demographic characteristics, diagnosis, past psychiatric history and treatment setting, and consecutive controls matched on date of discharge from in-patient care. RESULTS We matched 265 CTO cases with 265 matched controls and 224 consecutive controls (total n=754). The CTO group had a significantly higher readmission rate: 72% v. 65% and 59% for the matched and consecutive controls (log-rank chi(2)=4.7, P=0.03). CTO placement, aboriginal ethnicity, younger age, personality disorder and previous health service use were associated with increased admission rates. CONCLUSIONS Community treatment orders alone do not reduce admissions.
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Affiliation(s)
- Stephen R Kisely
- University Department of Psychiatry at Fremantle Hospital, University of Western Australia, Australia.
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Tuohimäki C, Kaltiala-Heino R, Korkeila J, Tuori T, Lehtinen V, Joukamaa M. Deprivation of liberty in Finnish psychiatric inpatients. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2004; 27:193-205. [PMID: 15063643 DOI: 10.1016/j.ijlp.2004.01.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
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Abstract
OBJECTIVE Assessing the public attitude to compulsory admission of mentally ill in Switzerland and analyzing the influence of demographic, psychological, and sociological factors. METHOD We conducted a representative telephone survey with 1737 interviewees. In a logistic regression analysis compulsory admission was used as the dependent variable. RESULTS More than 70% of the respondents display a positive attitude to compulsory admission. Education, negative stereotypes, and living in the French speaking part of Switzerland are predictors for accepting compulsory admission whereas older age, extreme political opinion, and rigid personality traits show an inverse effect. Negative emotions, anomie, social distance, and contact to mentally ill have no significant influence. CONCLUSION The mostly positive attitude to compulsory admission suggests that the public trust in psychiatry to deal with the assigned responsibility.
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Affiliation(s)
- Christoph Lauber
- Psychiatric University Hospital, Militärstrasse 8, PO Box 1930, CH-8021 Zurich, Switzerland.
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Crisanti AS, Love EJ. Characteristics of psychiatric inpatients detained under civil commitment legislation: a Canadian study. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2001; 24:399-410. [PMID: 11521417 DOI: 10.1016/s0160-2527(01)00075-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Affiliation(s)
- A S Crisanti
- Jail Diversion Project, Adult Mental Health Division, Department of Health, West Hawaii Mental Health Service, PO Box 664, Kealakekua, HI 96750, USA.
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