Impact of Psychiatrists’ Qualifications on the Rate of Compulsory Admissions

Abstract

Despite efforts to reduce coercion in psychiatry, involuntary hospitalizations remain frequent, representing more than half of all admissions in some European regions. Since October 2006, only certified psychiatrists are authorized to require a compulsory admission to our facility, while before all physicians were, including residents. The aim of the present study is to assess the impact of this change of procedure on the proportion compulsory admissions. All medical records of patients admitted respectively 4 months before and 4 month after the implementation of the procedure were retrospectively analyzed. This search retrieved a total of 2,227 hospitalizations for 1,584 patients. The overall proportions of compulsory and voluntary admissions were 63.9 % and 36.1 % respectively. The average length of stay was 32 days (SD ± 64.4). During the study period, 25 % of patients experienced two hospitalizations or more. The most frequent patients' diagnoses were affective disorders (30 %), psychotic disorders (18.4 %) and substance abuse disorders (15.7 %). Compared with the period before October 2006, patients hospitalized from October 2006 up were less likely to be hospitalized on a compulsory basis (OR = 0.745, 95 % CI: 0.596-0.930). Factors associated with involuntary admission were young age (20 years or less), female gender, a diagnosis of psychotic disorder and being hospitalized for the first time. Our results strongly suggest that limiting the right to require compulsory admissions to fully certified psychiatrists can reduce the rate of compulsory versus voluntary admissions.

Factors associated with disallowance of compulsory mental healthcare referrals

“…However, most other studies investigated general referrals for psychiatric care or involuntary referrals, without investigating eventual disallowance rates . Other studies with similar subjects were conducted in settings that were not comparable with the Norwegian system .…”

Coercion in mental healthcare: time for a change in direction

“…The 'front loading' of the assessment process with early involvement of senior clinicians should allow for a reduction in admissions, the rapid deploy ment of evidence-based interventions and the minimisation of coercion (Eytan et al, 2013). 'Front loading' is already used in systems where in-patient care is expensive (Harrison, 2004) and where risk and the need for restrictive measures are rapidly assessed.…”

Understanding U.S. debates surrounding standards in involuntary inpatient psychiatric commitment through the Maryland experience

“…Additionally, assessment of risk related to severe mental illness among members of different professions displayed considerable variation in determining risk of danger, and that professionals are easily swayed by small contextual changes in psychiatric situations. Indeed, a study of Swiss commitment proceedings comparing civil commitment prior to and following a law change that allowed only psychiatrists to involuntarily commit a person displayed a 25% decrease in the likelihood of commitment after the laws changed (Eytan, Chatton, Safran, & Khazaal, 2013).…”