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Mental health laws that require dangerousness for involuntary admission may delay the initial treatment of schizophrenia

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Abstract

Introduction

A long duration of untreated psychosis (DUP) is associated with a worse prognosis, an increased risk of suicide and may be linked to serious violence. Mental health laws that require patients to be dangerous to themselves or to others before they can receive involuntary psychiatric treatment may make it more difficult to treat patients in their first episode of psychosis.

Methods

The mean and median DUP reported in studies of schizophrenia related psychoses were examined. A comparison was made between the DUP reported from jurisdictions that had an obligatory dangerousness criterion (ODC) and those with other criteria for involuntary treatment.

Results

The average mean DUP in samples from jurisdictions with an ODC was 79.5 weeks, but was only 55.6 weeks in those jurisdictions that did not have an ODC (P < 0.007).

Conclusions

Mental health laws that require the patient to be assessed as dangerous before they can receive involuntary treatment are associated with significantly longer DUP. As reducing DUP is an intervention that can improve the prognosis of schizophrenia, this finding suggests that mental health laws should be amended to allow treatment on grounds other than dangerousness, at least in the crucial first episode of psychosis.

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Authors and Affiliations

  1. Private Practice, 326 South Dowling Street, Paddington, NSW, 2025, Australia

    Matthew M. Large BSc(Med), MBBS, FRANZCP &  Olav Nielssen MB, BS, MCrim, FRANZCP

  2. PO Box 110, Double Bay, NSW, 1360, Australia

    Matthew M. Large BSc(Med), MBBS, FRANZCP

  3. Clinical Research Unit for Anxiety Disorders, School of Psychiatry, UNSW at St Vincent’s Hospital, Darlinghurst, Sydney, NSW, Australia

    Olav Nielssen MB, BS, MCrim, FRANZCP

  4. Psychological Medicine, University of Sydney, Sydney, NSW, Australia

    Olav Nielssen MB, BS, MCrim, FRANZCP &  Christopher James Ryan MBBS, FRANZCP

  5. Westmead Hospital, Westmead, NSW, Australia

    Christopher James Ryan MBBS, FRANZCP

  6. Mental Health Research and Training Centre (MHRTC), Law School, University of Western Sydney, Campbelltown, NSW, Australia

    Robert Hayes LLB, PhD

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  1. Matthew M. Large BSc(Med), MBBS, FRANZCP
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  2. Olav Nielssen MB, BS, MCrim, FRANZCP
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  3. Christopher James Ryan MBBS, FRANZCP
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Correspondence to Matthew M. Large BSc(Med), MBBS, FRANZCP.

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Large, M.M., Nielssen, O., Ryan, C.J. et al. Mental health laws that require dangerousness for involuntary admission may delay the initial treatment of schizophrenia. Soc Psychiat Epidemiol 43, 251–256 (2008). https://doi.org/10.1007/s00127-007-0287-8

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  • DOI: https://doi.org/10.1007/s00127-007-0287-8

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