Social Psychiatry and Psychiatric Epidemiology

, Volume 40, Issue 8, pp 635–641 | Cite as

Compulsory admission and treatment in schizophrenia

A study of ethical attitudes in four European countries
  • Tilman Steinert
  • Peter Lepping
  • Réka Baranyai
  • Markus Hoffmann
  • Herbert Leherr
Original Paper


This study was conducted to compare attitudes of psychiatrists, other professionals, and laypeople towards compulsory admission and treatment of patients with schizophrenia in different European countries. Three case reports of patients with schizophrenia were presented to N=1,737 persons: 235 in England, 622 in Germany, 319 in Hungary, and 561 in Switzerland; 298 were psychiatrists, 687 other psychiatric or medical professionals, and 752 laypeople. The case reports presented typical clinical situations with refusal of consent to treatment (first episode and social withdrawal, recurrent episode and moderate danger to others and patient with multiple episodes and severe self-neglect). The participants were asked whether they would agree with compulsory admission and compulsory neuroleptic treatment. The rates of agreement varied between 50.8 and 92.1% across countries and between 41.1 and 93.6% across the different professional groups. In all countries, psychologists and social workers supported compulsory procedures significantly less than the psychiatrists who were in tune with laypeople and nurses. Country differences were highly significant showing more agreement with compulsion in Hungary and England and less in Germany and Switzerland (odds ratios up to 4.33). Own history of mental illness and having mentally ill relatives had no major impact on the decisions. Evidence suggests that compulsory procedures are based on traditions and personal attitudes to a considerable degree. Further research should provide empirical data and more definite criteria for indications of compulsive measures to achieve a common ethical framework for those critical decisions across Europe.


schizophrenia compulsory admission compulsory treatment involuntary treatment ethics attitudes 


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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Tilman Steinert
    • 1
  • Peter Lepping
    • 2
  • Réka Baranyai
    • 3
  • Markus Hoffmann
    • 1
  • Herbert Leherr
    • 4
  1. 1.Centre for Psychiatry WeiβenauWeiβenauGermany
  2. 2.West Cheshire HospitalChesterUK
  3. 3.Institute of Behavioural SciencesSemmelweis UniversityBudapestHungary
  4. 4.Psychiatric HospitalMuensterlingenSwitzerland

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