Psychiatric emergency room decision‐making, social control and the ‘undeserving sick’

Abstract

The influence of social factors on involuntary hospitalisation has been an important and controversial area of sociological focus for many years. Traditionally, social control theory has been used to understand disproportionate rates of involuntary hospitalisation among marginalised and powerless groups. However, dramatic changes in the social context of mental healthcare have necessitated a re-examination of the role of social factors in involuntary hospitalisation. In this study 287 psychiatric emergency room visits were examined in order to test hypotheses for understanding social influences on disposition. Little support for the traditional social control hypothesis was found. People from marginalised groups were not disproportionately involuntarily hospitalised, but instead were disproportionately treated and released from the hospital as people's social resources were used to access care rather than to prevent hospitalisation. This study highlights the importance of the historical relevance of our theoretical understanding of the relationship between social factors and involuntary commitment.

Are there racial differences in the way patients with psychotic disorders are treated at their first hospitalization?

“…05). Thus, consistent with previous reports of racial differences in psychiatric emergency-room care (Segal et al 1996;Lincoln, 1998), it is possible that race influenced referral patterns from the psychiatric emergency room. However, there are other possible explanations for race patterns in referrals to specific facilities, including availability of appropriate substance abuse treatment services, availability of residential facilities for patients without strong family support and geographic location of either the hospital or the affiliated out-patient clinics.…”

Pathways to Mental Health Services and Perceptions about the Effectiveness of Treatment

“…This set of findings linking demographic, socioeconomic, and health status characteristics with pathways to care and treatment effectiveness contributes to the body of research that seeks to understand how people come to use mental health services. Most of the research examining social characteristics and treatment has focused on receipt of any treatment in specific settings (Farmer et al 2003;Mojtabai et al 2012) or looked at predictors and outcomes of coercion or involuntary hospitalization (Lincoln 2006;Link, Castille, and Stuber 2008) and ignored how one got into care. To our knowledge, this is the first study that identifies sociodemographic and health status factors associated with different pathways to care and perceived outcomes of care in a national representative sample.…”

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

“…We chose to group the five types of expectations in two main categories, the category of ‘Examining and treating’ (including the expectations ‘Treatment with neuroleptics’, ‘Implement extensive changes in treatment and follow-up,’ and ‘Resolve an unclear diagnosis’) and the category of ‘Giving care’ (including the expectations ‘Take care of the patient’ and ‘Simply solve an acute situation’). While the referring doctors could have several expectations, we believe this categorization is useful in illustrating that other aspects than the purely medical may be important to the referring GPs when considering the involuntary admission of patients [ 30 ].…”