Compulsory Admission to Psychiatric Wards–Who Is Admitted, and Who Appeals Against Admission?

Arnold, Benjamin F.; Moeller, Julian; Hochstrasser, Lisa; Schneeberger, Andres R.; Borgwardt, Stefan; Lang, Undine E.; Huber, Christian G.

doi:10.3389/fpsyt.2019.00544

Cited by 19 publications

(24 citation statements)

References 37 publications

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“…Finally, although previous research identified high rates of coercive measures for male gender (12), and other studies have shown female persons to be more often exposed to coercion (15), our study revealed no significant difference in approval of coercion regarding the gender of the fictitious person or participants.…”

Section: Discussioncontrasting

confidence: 95%

“…Male gender and migratory background are associated with coercion (12)(13)(14). However, regarding gender, some studies also reported an increased risk for coercive measures in females compared to male patients (15,16). Concerning dangerousness, numerous studies found that persons with actual or impending danger to self or others are at high risk of compulsory admission (17,18).…”

Section: Introductionmentioning

confidence: 99%

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Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization

et al. 2022

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Background: Coercion is routinely used in psychiatry. Its benefits and drawbacks are controversially debated. In addition, the majority of persons with mental health problems are exposed to stigmatization and are assumed to be dangerous. Stigmatization is associated with negative consequences for individuals with mental illness such as disapproval, social rejection, exclusion, and discrimination. Being subjected to coercive measures can increase the stigmatization of the affected persons, and stigmatization might lead to higher approval for coercion.Aims of the Study: This study aims to examine the approval for coercive measures in psychiatry by the general public, and to explore its relation with person- and situation-specific factors as well as with stigmatization.Method: We conducted a representative survey of the general population (N = 2,207) in the canton of Basel-Stadt, Switzerland. Participants were asked to read a vignette depicting psychopathological symptoms of a fictitious character and indicate whether they would accept coercive measures for the person in the vignette. Desire for social distance and perceived dangerousness were assessed as measures of stigmatization.Findings: The person in the case vignette exhibiting dangerous behavior, showing symptoms of a psychotic disorder, being perceived as dangerous, and treatment being understood as helpful increased approval of coercion in general, while familiarity of the respondents with mental illness decreased approval.Conclusions: The public attitude regarding the approval of coercion in psychiatry is highly differentiated and largely follows the current legal framework and medical treatment guidelines. Higher approval occurred in situations of self-harm or harm to others and when coercive measures were thought to have a beneficial effect for the affected persons. A considerable part of the approval for coercion is predicted by stigmatization. With the increasing severity of coercive measures, the influence of person- and situation-specific factors and of familiarity with mental illness decreased and generalizing and stigmatizing attitudes became stronger predictors for the approval of more severe measures.

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Section: Discussioncontrasting

confidence: 95%

Section: Introductionmentioning

confidence: 99%

Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization

et al. 2022

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“…treatment on a closed ward) may increase violent behavior (16,17). However, further research is needed (3,18).…”

Section: The Pros and Cons Of Closed Doors In Psychiatrymentioning

confidence: 99%

Opening the Doors of a Substance Use Disorder Ward—Benefits and Challenges From a Consumer Perspective

et al. 2020

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Open doors in psychiatry have been a subject of controversy in recent years. While some studies postulate the clinical necessity of closed doors, others challenge the theoretical advantages of this setting, mention numerous drawbacks of closed wards, and focus on the advantages of open-door settings. With regard to patients diagnosed with substance use disorders (SUD), other standards may apply. Very little research has been done on this topic. Some studies adopted a consumer perspective (i.e. asking involved parties about their experience of the door status). To the authors' knowledge, no study has so far addressed the ideal setting for the treatment of SUD. With our data from the opening of a specialized SUD ward, we take one step to closing this knowledge gap. Applying a qualitative design, we asked patients and health care professionals (HCP) to report changes following the opening of the ward. The results are mainly in line with the literature on the general psychiatric population. The newly introduced open-door setting was mostly perceived as positive, but some disadvantages were mentioned (e.g. less protection of patients, less control over who enters/leaves the ward, the theoretically increased risk of patients absconding). Moreover, HCP (but not patients) mentioned potentially increased substance use on the ward as an additional disadvantage that could arise. Opening a previously closed ward was generally perceived as a positive and progressive decision. These findings support the trend towards an overall open-door policy in psychiatry.

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“…Age is related to the risk of compulsory admissions, although under different circumstances [8–11]. Organic, psychotic, and bipolar disorders are related to a higher rate of compulsory admissions [10–14], while affective and substance use disorders are related to a higher rate of voluntary admissions [12]. Several accompanying clinical features, such as aggression, disruptive behavior, suicidal thoughts, and cognitive impairment, have been considered risk factors.…”

Section: Introductionmentioning

confidence: 99%

Impact of compulsory admission on treatment and outcome: A propensity score matched analysis

et al. 2022

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Background Despite multiple ethical issues and little evidence of their efficacy, compulsory admission and treatment are still common psychiatric practice. Therefore, we aimed to assess potential differences in treatment and outcome between voluntarily and compulsorily admitted patients. Methods We extracted clinical data from inpatients treated in an academic hospital in Zurich, Switzerland between January 1, 2013 and December 31, 2019. Observation time started upon the first admission and ended after a one-year follow-up after the last discharge. Several sociodemographic and clinical characteristics, including Health of the Nation Outcome Scales (HoNOS) scores, were retrospectively obtained. We then identified risk factors of compulsory admission using logistic regression in order to perform a widely balanced propensity score matching. Altogether, we compared 4,570 compulsorily and 4,570 voluntarily admitted propensity score-matched patients. Multiple differences between these groups concerning received treatment, coercive measures, clinical parameters, and service use outcomes were detected. Results Upon discharge, compulsorily admitted patients reached a similar HoNOS sum score in a significantly shorter duration of treatment. They were more often admitted for crisis interventions, were prescribed less pharmacologic treatment, and received fewer therapies. During the follow-up, voluntarily admitted patients were readmitted more often, while the time to readmission did not differ. Conclusions Under narrowly set circumstances, compulsory admissions might be helpful to avert and relieve exacerbations of severe psychiatric disorders.

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Compulsory Admission to Psychiatric Wards–Who Is Admitted, and Who Appeals Against Admission?

Cited by 19 publications

References 37 publications

Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization

Approval of Coercion in Psychiatry in Public Perception and the Role of Stigmatization

Opening the Doors of a Substance Use Disorder Ward—Benefits and Challenges From a Consumer Perspective

Impact of compulsory admission on treatment and outcome: A propensity score matched analysis

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