Crucial factors preceding compulsory psychiatric admission: a qualitative patient-record study

Abstract

BackgroundCompulsory admissions have a strong effect on psychiatric patients and represent a deprivation of personal liberty. Although the rate of such admissions is tending to rise in several Western countries, there is little qualitative research on the mental health-care process preceding compulsory admission. The objective of the study was to identify crucial factors in the mental health-care process preceding compulsory admission of adult psychiatric patients.MethodsThis retrospective, qualitative multiple-case study was based on the patient records of patients with severe mental illness, mainly schizophrenia and other psychotic disorders. Twenty two patient records were analyzed. Patients’ demographic and clinical characteristics were heterogeneous. All were treated by Flexible Assertive Community Treatment teams (FACT teams) at two mental health institutions in the greater Rotterdam area in the Netherlands and had a compulsory admission in a predefined inclusion period. The data were analyzed according to the Prevention and Recovery System for Monitoring and Analysis (PRISMA) method, assessing acts, events, conditions, and circumstances, failing protective barriers and protective recovery factors.ResultsThe most important patient factors in the process preceding compulsory admission were psychosis, aggression, lack of insight, care avoidance, and unauthorized reduction or cessation of medication. Neither were health-care professionals as assertive as they could be in managing early signs of relapse and care avoidance of these particular patients.ConclusionThe health-care process preceding compulsory admission is complex, being influenced by acts, events, conditions and circumstances, failing barriers, and protective factors. The most crucial factors are patients’ lack of insight and cessation of medication, and health-care professionals’ lack of assertiveness.Electronic supplementary materialThe online version of this article (10.1186/s12888-017-1512-y) contains supplementary material, which is available to authorized users.

Use of Acute Psychiatric Hospitalisation: A Study of the Factors Influencing Decisions to Arrange Acute Admission to Inpatient Mental Health Facilities

“…Discussions with a representative group of decision-makers found a wide range of factors that fell within four broad themes. Similar to previous findings (6,10,11,20), the clinical/risk factor theme encompasses issues that would be expected to influence decision-making (e.g., the clinical history, associated risks and the viability of alternatives to admission). This study demonstrated that clinician decision-making was influenced by wider factors that are rarely explicitly examined in studies of psychiatric admissions.…”

“…The limited literature that exists identifies crisis stabilisation, potential for harm and mental state acuity as key reasons for emergency admission [e.g., (7)(8)(9)(10)(11)]. The ways these decisions are made in practise are not well-understood and clinical experience points to significant variability.…”

An intensive multimodal group programme for patients with psychotic disorders at risk of rehospitalization: a controlled intervention study

“…Once back in FACT Plus, they could then be monitored more closely. It is also possible that this closer contact resulted in fewer – zero versus nine – compulsory admissions, a subcategory of admissions which indicates high illness severity and low treatment adherence [14, 15].…”

Factors associated with involuntary psychiatric hospitalization in Portugal

“…Involuntary hospitalization is now seen as the way to achieve the highest attainable standard of health when a severe exacerbation of illness impairs decision-making capacity [ 3 ], and can be lifesaving [ 4 ]. However, it represents a deprivation of personal liberty and a suspension of legal capacity [ 5 ], and conflicts with the right to personal autonomy and to make decisions about one’s own treatment [ 6 ]. Existing observational studies suggest that involuntarily admitted patients show limited clinical and social improvement [ 7 – 11 ], with mixed evidence on the impact on suicidality [ 11 , 12 ].…”