Involuntary psychiatric admission: The referring general practitioners’ assessment of patients’ dangerousness and need for psychiatric hospital treatment

Røtvold, Ketil; Wynn, Rolf

doi:10.3109/08039488.2015.1046915

Cited by 16 publications

(16 citation statements)

References 31 publications

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“…GPs working at out-of-hours clinics feel much uncertainty with complex issues and they have little time and few available interventions [ 26 , 47 ]. 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 ].…”

Section: Resultsmentioning

confidence: 99%

Involuntary admission in Norwegian adult psychiatric hospitals: a systematic review

Wynn

2018

Int J Ment Health Syst

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BackgroundIt is an important objective of the psychiatric services to keep the use of involuntary procedures to a minimum, as the use of coercion involves clinical, ethical, and legal issues. It has been claimed that Norway has a relatively high rate of involuntary admissions. We reviewed the peer-reviewed literature on the use of involuntary admission in Norway, with the purpose of identifying the current state of knowledge and areas in need of further research.MethodsA systematic review following the PRISMA statement was conducted. We searched the electronic databases PsycInfo, PubMed, Web of Science, CINAHL, and Embase for studies relating to involuntary admission to Norwegian adult psychiatric hospitals published in the period 1 January 2001 to 8 August 2016. The database searches were supplemented with manual searches of relevant journals, reference lists, and websites.ResultsSeventy-four articles were included and grouped into six categories based on their main topics: Patients’ experiences, satisfaction and perceived coercion (21 articles), the Referral and admission process (11 articles), Rates of admission (8 articles), Characteristics of the patients (17 articles), Staff attitudes (9 articles), and Outcomes (8 articles). Four of the included articles described intervention studies. Fifty-seven of the articles had a quantitative design, 16 had a qualitative design, and one a mixed-method design. There was a broad range of topics that were studied and considerable variation in study designs. The findings were largely in line with the international literature, but the particularities of Norwegian legislation and the Norwegian health services were reflected in the literature. The four intervention studies explored interventions for reducing rates of involuntary admission, such as modifying referring routines, improving patient information procedures, and increasing patients’ say in the admission process, and represent an important avenue for future research on involuntary admission in Norway.ConclusionsThe review suggests that Norway has a relatively high rate of involuntary admissions. The identified studies represent a broad mix of topics and designs. Four intervention studies were identified. More studies with strong designs are needed to bring research on involuntary admission in Norway to a next level.Electronic supplementary materialThe online version of this article (10.1186/s13033-018-0189-z) contains supplementary material, which is available to authorized users.

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Section: Resultsmentioning

confidence: 99%

Involuntary admission in Norwegian adult psychiatric hospitals: a systematic review

Wynn

2018

Int J Ment Health Syst

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“…Feiring and Ugstad [ 20 ] found that many RCs were reluctant to assess whether a patient was at risk of harming others or societal consequences of untreated mental disorders. Assessing patients’ potential dangerousness is also challenging for GPs [ 9 ]. In Norway, the MHA has been founded on a strong treatment philosophy [ 46 ], and clinicians may find it less stigmatizing to refer to patients’ treatment needs than to dangerousness.…”

Section: Discussionmentioning

confidence: 99%

“…The legal criteria for involuntary hospitalization and CTOs, which are identical, are based on the presence of severe mental illness (SMI) [ 8 ]. CTOs have been referred to as a less restrictive treatment option than involuntary hospitalization, either to improve or restore patients’ health or prevent significant deterioration in the very near future (‘treatment criterion’) [ 9 ]. Commitment may also be used if the person is likely to pose an obvious and serious risk to his/her own life or health or that of others (‘dangerousness criterion’).…”

Section: Introductionmentioning

confidence: 99%

How clinicians make decisions about CTOs in ACT: a qualitative study

Stuen

Landheim

Rugkåsa

et al. 2018

Int J Ment Health Syst

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BackgroundThe first 12 Norwegian assertive community treatment (ACT) teams were piloted from 2009 to 2011. Of the 338 patients included during the teams’ first year of operation, 38% were subject to community treatment orders (CTOs). In Norway as in many other Western countries, the use of CTOs is relatively high despite lack of robust evidence for their effectiveness. The purpose of the present study was to explore how responsible clinicians reason and make decisions about the continued use of CTOs, recall to hospital and the discontinuation of CTOs within an ACT setting.MethodsSemi-structured interviews with eight responsible clinicians combined with patient case files and observations of treatment planning meetings. The data were analysed using a modified grounded theory approach.ResultsThe participants emphasized that being part of a multidisciplinary team with shared caseload responsibility that provides intensive services over long periods of time allowed for more nuanced assessments and more flexible treatment solutions on CTOs. The treatment criterion was typically used to justify the need for CTO. There was substantial variation in the responsible clinicians’ legal interpretation of dangerousness, and some clinicians applied the dangerousness criterion more than others.ConclusionsAccording to the clinicians, many patients subject to CTOs were referred from hospitals and high security facilities, and decisions regarding the continuation of CTOs typically involved multiple and interacting risk factors. While patients’ need for treatment was most often applied to justify the need for CTOs, in some cases the use of CTOs was described as a tool to contain dangerousness and prevent harm.

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“…While we lack data explaining these differences, we might speculate that whether the patients were believed to be of danger to themselves or others was an important factor in the considerations of the referring doctors, and that patients suffering from psychoses relatively more often might have been considered dangerous than for instance patients suffering from anxiety disorders. 17 , 24 …”

Section: Discussionmentioning

confidence: 99%

How mental health service systems are organized may affect the rate of acute admissions to specialized care: Report from a natural experiment involving 5338 admissions

2017

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Objectives:Studies on the dynamics between service organization and acute admissions to psychiatric specialized care have given ambiguous results. We studied the effect of several variables, including service organization, coercion, and patient characteristics on the rate of acute admissions to psychiatric specialist services. In a natural experiment-like study in Norway, we compared a “deinstitutionalized” and a “locally institutionalized” model of mental health services. One had only community outpatient care and used beds at a large Central Mental Hospital; the other also had small bed-units at the local District Psychiatric Centre.Methods:From the case registries, we identified a total of 5338 admissions, which represented all the admissions to the psychiatric specialist services from 2003 to 2006. The data were analyzed with chi-square tests and Z-tests. In order to control for possible confounders and interaction effects, a multivariate analysis was also performed, with a logistic regression model.Results:The use of coercion emerged as the strongest predictor of acute admissions to specialist care (odds ratio = 7.377, 95% confidence interval = 4.131–13.174) followed by service organization (odds ratio = 3.247, 95% confidence interval = 2.582–4.083). Diagnoses of patients predicted acute admissions to a lesser extent. We found that having psychiatric beds available at small local institutions rather than beds at a Central Mental Hospital appeared to decrease the rate of acute admissions.Conclusion:While it is likely that the seriousness of the patients’ condition is the most important factor in doctors’ decisions to refer psychiatric patients acutely, other variables are likely to be important. This study suggests that the organization of mental health services is of importance to the rate of acute admissions to specialized psychiatric care. Systems with beds at local District Psychiatric Centers may reduce the rate of acute admissions to specialized care, compared to systems with local community outpatient services and beds at Central Mental Hospitals.

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Involuntary psychiatric admission: The referring general practitioners’ assessment of patients’ dangerousness and need for psychiatric hospital treatment

Abstract: While the danger criterion was applied by a majority, the treatment criterion was also chosen by many and was of importance to the doctors' reasoning regarding referrals to involuntary admission. Most thought they could not have chosen a different criterion.

Cited by 16 publications

References 31 publications

Involuntary admission in Norwegian adult psychiatric hospitals: a systematic review

Involuntary admission in Norwegian adult psychiatric hospitals: a systematic review

How clinicians make decisions about CTOs in ACT: a qualitative study

How mental health service systems are organized may affect the rate of acute admissions to specialized care: Report from a natural experiment involving 5338 admissions

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