Coerced Hospital Admission and Symptom Change—A Prospective Observational Multi-Centre Study

Abstract

IntroductionCoerced admission to psychiatric hospitals, defined by legal status or patient's subjective experience, is common. Evidence on clinical outcomes however is limited. This study aimed to assess symptom change over a three month period following coerced admission and identify patient characteristics associated with outcomes.MethodAt study sites in 11 European countries consecutive legally involuntary patients and patients with a legally voluntary admission who however felt coerced, were recruited and assessed by independent researchers within the first week after admission. Symptoms were assessed on the Brief Psychiatric Rating Scale. Patients were re-assessed after one and three months.ResultsThe total sample consisted of 2326 legally coerced patients and 764 patients with a legally voluntary admission who felt coerced. Symptom levels significantly improved over time. In a multivariable analysis, higher baseline symptoms, being unemployed, living alone, repeated hospitalisation, being legally a voluntary patient but feeling coerced, and being initially less satisfied with treatment were all associated with less symptom improvement after one month and, other than initial treatment satisfaction, also after three months. The diagnostic group was not linked with outcomes.DiscussionOn average patients show significant but limited symptom improvements after coerced hospital admission, possibly reflecting the severity of the underlying illnesses. Social factors, but not the psychiatric diagnosis, appear important predictors of outcomes. Legally voluntary patients who feel coerced may have a poorer prognosis than legally involuntary patients and deserve attention in research and clinical practice.

Quality of Life and Functioning One Year After Experiencing Accumulated Coercive Events During Psychiatric Admission

“…While research to date has reported no association between coercion and quality of life (QoL) or functioning during admission (6, 7) other studies have found that coercion during admission can predict prognosis and QoL up to one year after discharge (8,9). However, most of these studies did not take into account the total amount of coercion experienced by the service user as they compared some types of coercion only.…”

Admission without consent and use of means of physical coercion on the example of psychiatric hospital in Wrocław

“…These studies clearly indicate that the use of coercive measures in psychiatric treatment is often, though very diversified, which should encourage further monitoring of this phenomenon and looking for the way to limit it, considering the experiences of other countries [21]. Particularly important is to conduct such studies in institutions that in the past years were characterised by relatively high ratio of using coercive measures [14,19,20].…”

“…The follow-up observation showed a connection between involuntary admission and more often use of coercive measures during hospitalisation [16,17]. It also showed that the feeling of coercion [18] was more common among patients admitted voluntarily than among involuntarily admitted patients, which had an effect on the entire process of therapy and cooperation during treatment (phenomenon known as compliance) [19].…”

“…Referring to the results of Polish [3][4][5]18] and international [16,17,19,[20][21][22][23] studies, it was decided to assess the incidence of coercive measures used in relation to patients' admission to a psychiatric hospital, and to assess the use of coercive measures in the psychiatric hospital in Wrocław (currently Lower Silesian Mental Health Centre, LSMHC).…”

“…Wykazano również, że odczuwanie przymusu [18] było silniejsze wśród pacjentów, którzy byli przyjęci za zgodą niż wśród przyjętych bez zgody, co miało wpływ na całościowy proces terapii i współpracę podczas leczenia (tzw. compliance) [19].…”