Characteristics of Psychiatric Emergency Situations and the Decision-Making Process Leading to Involuntary Admission

Abstract

Introduction: Involuntary admissions to psychiatric hospitals, regardless of their beneficial effects, violate the patients' autonomy. To keep such measures at a minimum and develop less restricting and coercive alternatives, a better understanding of the psychiatric emergency situations which end up in involuntary admissions is needed. This descriptive and exploratory study investigates the consultations leading to involuntary admission and the decision-making process of the referring physicians.Methods: We developed an online questionnaire to collect data on the characteristics of the consultation leading to an involuntary admission, including influencing factors from the referring physicians‘ perspective, as well as their professional background. We included 107 physicians who completed the questionnaire after they had referred patients for involuntary admission to one major psychiatric hospital in Switzerland.Results: The referring physicians were heterogeneous regarding their medical background and experience with psychiatric emergency situations. The consultations were time consuming and took place in various locations. Clinical findings, third-party anamnesis and a known psychiatric diagnosis contributed strongest to the decision to admit involuntarily. “Protection from danger to self” was named most frequently as purpose of the admission.Discussion: This study emphasizes the variety of psychiatric emergency situations leading to involuntary admissions. In most cases, several parties are involved and influence the decision together with medical and social factors. To reduce the number of involuntary admissions, alternatives for patients with a high symptom load and at risk of harming themselves are needed. Possible approaches to achieve that reduction and recommendations for further research are provided.

Involuntary admission of psychiatric patients: Referring physicians’ perceptions of competence

“…Of those, 16 (15%) had referred more than 10 patients involuntarily during this period. The sample is described in more details in another publication elsewhere (Marty et al, 2018).…”

“…During the study, we also assessed details on the PES and legal considerations of the referring physicians as well as their compliance with the law. Those are described in detail elsewhere (Hotzy et al, 2019; Marty et al, 2018).…”

The predictive validity of the V-RISK-10 and BVC among involuntarily admitted patients

“…Additionally, it gives further insight into criteria that are critical to the treatment process of this specific population, such as coercive measures and violence. Given the ethical challenges of involuntary admissions, the findings highlight that both instruments might facilitate more objective evaluations, mitigating potential bias stemming from subjective impressions, time-consuming procedures, and pressure by third parties during the admission process ( 37 , 38 ). Because both instruments do not require a specific training, they could support the evaluation process during an involuntary admission, possibly even for professionals without medical expertise ( 39 ).…”

Predicting involuntary hospitalization in psychiatry: A machine learning investigation

“…A previous study had already highlighted the association between physicians' qualifications and coercion rates, showing that limiting the right to require involuntary admission to psychiatrists could reduce the use of compulsion [16]. Another study in Zurich, Switzerland, showed that referring general practitioners found it more difficult to apply legal criteria for involuntary admission and to assess its necessity [72]. GPs also provided the lowest quality commitment certificates [73,74].…”