Involuntary psychiatric admission: how the patients are detected and the general practitioners’ expectations for hospitalization. An interview-based study

Abstract

BackgroundIn Norway, it is usually GPs that refer patients to involuntary admission. A high proportion of such referrals come from out-of-hours clinics. Little is known about who first initiate the contact between the patients and the referring doctors and which expectations the referring doctors have with respect to the involuntary admissions. The aim of the study was to examine who first detected the patients who were subsequently involuntarily admitted, and to examine the referring doctors’ expectations for the admissions.MethodsSemi-structured interviews with 74 doctors that had referred patients for involuntary admission at a psychiatric hospital.ResultsPatients who were involuntarily admitted were detected by other branches of the health service (52 %, n = 39), family (25 %, n = 19), and the police (17 %, n = 13). The doctors mentioned these expectations for the admission (more than one expectation could be given): start treatment with neuroleptics: 58 % (n = 43), take care of the patient: 45 % (n = 34), extensive changes to the treatment regime: 37 % (n = 28), solve an acute situation: 35 % (n = 26), and clarify the diagnosis: 22 % (n = 17). Female doctors significantly more often expected that the patients would be examined and treated, while the male doctors significantly more often expected that the patients would be cared for.ConclusionsInvoluntary admissions are typically complex processes involving different people and services and patients with various needs. More knowledge about the events preceding hospitalization is needed in order to develop alternatives to involuntary admissions.Electronic supplementary materialThe online version of this article (doi:10.1186/s13033-016-0048-8) contains supplementary material, which is available to authorized users.

Involuntary admission in Norwegian adult psychiatric hospitals: a systematic review

“…Eleven studies [ 26 , 27 , 44 – 52 ] examined the topic of the referral and/or the admission of involuntary patients to psychiatric hospitals. The studies were primarily based on the examination of medical records [ 44 – 48 , 52 ] or on interviews with referring GPs [ 26 , 49 – 51 ] or admitting specialists [ 27 ]. In this category, two of the 11 studies were qualitative [ 26 , 27 ].…”

“…Many referring doctors find it difficult to apply the legal criteria [ 49 ] and one study [ 50 ] found that the danger criterion had been used most often. The most frequent expectations for the involuntary admissions are the starting of treatment with neuroleptics and taking care of the patient [ 51 ]. While one study found that referring GPs and admitting specialists were mostly in agreement [ 45 ], other studies had found that 27% [ 52 ], 45% [ 46 ], and 54% [ 44 ] were disallowed, i.e.…”

“…Furthermore, being non-Norwegian and being unknown to the referring doctor also seems to increase the likelihood of being committed. These factors could possibly be explained by considering that they either represent difficulties in communication (being unknown and/or non-Norwegian) or that they represent some form of actual or perceived danger (severe illness, emergency situation, male, violence, police involvement), two themes that might be particularly important when GPs make assessment regarding referrals to involuntary admission [ 26 , 51 ]. Studies from different countries suggest that predictors of involuntary admission may vary between countries, possibly because of differences in cultural factors [ 94 ], factors related to the health services, legislation, or other factors.…”

Outcomes of involuntary psychiatric commitment: An integrative review

“…[5] Methods in implementing psychiatric commitment include consideration of individual's autonomy, and decision-making powers or referrals which may follow mandates that place the power to decide to non-medical authorities such as judges, courts, government officials, or social workers as well as family or significant others and decisions of the mental health professionals according to legal provisions. [6] Bola and col-leagues' study [7] in South Korea revealed that more than half (66%-77%) of involuntary admissions were referred primarily by the family while Rotvold and Wynn [8] accounted 25% in their study. Family involvement in the involuntary admission of the patient may pose long-term consequences in terms of relationship with the patient.…”

The relationship between the services available to patients in primary care and at local psychiatric clinics and the use of coercion: recent findings from Northern Norway

“…For instance, approximately half of the involuntary admissions had been referred from doctors working at municipal out-of-hours clinics [5]. These doctors often felt pressured to commit patients to psychiatric hospital, as few other options were available at nights and week-ends [5][6][7]. The increased availability of other services at nights and week-ends could therefore possibly result in reduced levels of coercion.…”