Compulsory admissions and preferences in decision-making in patients with psychotic and bipolar disorders
Participation in medical decisions and taking into account patients’ values and preferences are especially important for psychiatric patients who may be treated against their will. The increasing rates of coercive measures and the underlying clinical, ethical, and legal issues highlight the need to examine their use in psychiatry. Although limited congruence in decision-making preferences may be on the basis of these coercive practices, this issue has not been adequately addressed. We explore the relationship between compulsory admissions and congruence in decision-making preferences in mental health settings.
Cross-sectional study among 107 outpatients with DSM diagnoses of schizophrenia of bipolar disorder using the Control Preference Scale to assess congruence in decision-making experienced and preferred style. History of compulsory admissions was obtained through review of available records. Descriptive statistics and multivariate analyses were used.
70% of patients reported experiencing their preferred style of decision-making and 44% patients had history of compulsory admissions. These patients were more autonomous and preferred to take a more active role. The degree of congruence was lower in patients with previous compulsory admissions. The best predictors of compulsory admissions were not having a regular doctor and the unmatched participation preferences.
Patients who experienced a different level of participation in decision-making than desired more frequently had compulsory admissions. We propose to assess participation preferences each time a relevant treatment decision is about to be made and tailor care accordingly. We identified several factors leading to compulsory admissions that can be modified to prevent further coercive measures.
KeywordsCoercion Patient admissions Risk factors Psychiatry Decision-making Patient participation
We would like to thank everyone who participated in the study and Dr Ibañez-López and Dra Ruiz-Merino for their statistical advice.
Compliance with ethical standards
All authors declare that the submitted work has not been published before and that the work is not under consideration for publication elsewhere.
Conflict of interest
On behalf of all authors, the corresponding author states that there is no conflict of interest.
This study has been approved by the ethics committee of our referral hospital and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Spanish laws have been observed, too.
- 1.European Parliament and the Council of the European Union. Convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine: convention on human rights and biomedicine. 4. 1997. European Treaty Series. No. 164 https://rm.coe.int/1680084824. Accessed 01 May 2019
- 2.Official State Gazette (2002) Law 41/2002, of 14 November, regulating patient autonomy and rights and obligations of information and clinical documentation. 274, 40126–40132Google Scholar
- 3.Official State Gazette (2000) Law 1/2000, of 7 January on civil procedure. Article 763 compulsory internment due to psychic disorder. 7 708Google Scholar
- 4.Kallert TW, Glöckner M, Onchev G, Raboch J, Karastergiou A, Solomon Z, Magliano L, Dembinskas A, Kiejna A, Nawka P, Torres-Gonzales F, Priebe S, Kjellin L (2005) The EUNOMIA project on coercion in psychiatry: study design and preliminary data. World Psychiatr 4:168–172Google Scholar
- 7.Rodríguez-Jiménez J. UHB Map Project. III Jornada de Unidades de Hospitalización Breve. 2018. Valencia. http://isanidad.com/127753/el-60-de-los-ingresos-en-unidades-de-hospitalizacion-breve-de-psiquiatria-son-voluntarios/. Accessed 05 Jun 2019
- 8.Asociación Española de Neuropsiquiatría. Manifiesto de Cartagena. XXXVI Jornadas de la AEN. 2016. Cartagena. https://aen.es/blog/2016/06/05/manifiesto-en-torno-a-la-coercion-en-los-servicios-de-salud-mental/. Accessed 28 May 2019
- 9.Comité Jurídico de Confederación SALUD MENTAL ESPAÑA (2018) Informe sobre el estado de los DERECHOS HUMANOS de las personas con trastorno mental en España 2017. Licencia de contenidos Creative Commons: Reconocimiento—No Comercial (by-nc), MadridGoogle Scholar
- 10.Mendez J (2013) Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment. United Nations: Human Rights Council, 22nd session. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G13/105/77/PDF/G1310577.pdf?OpenElement. Accessed 01 Mar 2019
- 12.Metz MJ, Veerbeek MA, Twisk WR, van der Feltz-Cornelis CM, de Beurs E, Beekman AT (2019) Shared decision-making in mental health care using routine outcome monitoring: results of a cluster randomised-controlled trial. Soc Psychiatr Psychiatr Epidemiol 54:209–219. https://doi.org/10.1007/s00127-018-1589-8 CrossRefGoogle Scholar
- 14.Valenti E, Banks C, Calcedo-Barba A, Bensimon CM, Hoffmann KM, Pelto-Piri V, Jurin T, Márquez-Mendoza O, Mundt AP, Rugkasa J, Tubini J, Priebe S (2015) Informal coercion in psychiatry: a focus group study of attitudes and experiences of mental health professionals in ten countries. Soc Psychiatr Psychiatr Epidemiol 50:1297–1308. https://doi.org/10.1007/s00127-015-1032-3 CrossRefGoogle Scholar
- 18.Hamann J, Kohl S, McCabe R, Bühner M, Mendel R, Albus M (2016) What can patients do to facilitate shared decision making? A qualitative study of patients with depression or schizophrenia and psychiatrists. Soc Psychiatr Psychiatr Epidemiol 51:617–625. https://doi.org/10.1007/s00127-015-1089-z CrossRefGoogle Scholar
- 21.Oliva F, Ostacoli L, Versino E, Portigliatti Pomeri A, Furlan PM, Carletto S, Picci RL (2019) Compulsory psychiatric admissions in an italian urban setting: are they actually compliant to the need for treatment criteria or arranged for dangerous not clinical condition? Front Psychiatr 9:740. https://doi.org/10.3389/fpsyt.2018.00740 CrossRefGoogle Scholar
- 22.American Psychiatric Association (2014) Diagnostic and statistical manual of mental disorders. American Psychiatric Publishing, WashingtonGoogle Scholar
- 23.Lobo A, Saz P, Marcos G, Día JL, de la Cámara C, Ventura T, Morales-Asín F, Fernando-Pascual L, Montañés JA, Aznar S (1999) Revalidation and standardization of the cognition mini-exam (first Spanish version of the Mini-Mental Status Examination) in the general geriatric population. Med Clin 112:767–774Google Scholar
- 24.Ventura MA, Green MF, Shaner A et al (1993) Training and quality assurance with the Brief Psychiatric Rating Scale: “The drift buster”. Int J Meth Psych Res 3:221–244Google Scholar
- 34.Comitè de Bioètica de Catalunya (2017) El respeto a la voluntad de la persona con trastorno mental y/o adicción: documento de voluntades anticipadas y planificación de decisiones anticipadas. https://www.researchgate.net/publication/323677344_El_respecte_a_la_voluntat_de_la_persona_amb_trastorn_mental_io_addiccio_document_de_voluntats_anticipades_i_planificacio_de_decisions_anticipades. Accessed 02 Feb 2019
- 36.Farrelly S, Brown G, Rose D, Doherty E, Claire Henderson R, Birchwood M, Marshall M, Waheed W, Szmukler G, Thornicroft G (2014) What service users with psychotic disorders want in a mental health crisis or relapse: thematic analysis of joint crisis plans. Soc Psychiatr Psychiatr Epidemiol 49:1609–1617. https://doi.org/10.1007/s00127-014-0869-1 CrossRefGoogle Scholar
- 38.Hamann J, Mendel R, Cohen R, Heres S, Ziegler M, Buhner M, Kissling W (2009) Psychiatrists’ Use of shared decision making in the treatment of schizophrenia: patient characteristics and decision topics. Psychiatr Serv 60:1107–1112. https://doi.org/10.1176/appi.ps.60.8.1107 CrossRefPubMedGoogle Scholar
- 41.Kasilova L, Raboch J, Sampogna G, Cihal L, Kallert TW, Onchev G, Karastergiou A, del Vecchio V, Kiejna A, Admowski T, Torres-Gonzales F, Cervilla JA, Priebe S, Giacco D, Kjellin L, Dembinskas A, Fiorillo A (2014) Do patients and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study. Soc Psychiatr Psychiatr Epidemiol 49:1619–1629. https://doi.org/10.1007/s00127-014-0872-6 CrossRefGoogle Scholar
- 43.Gabbard GO (1992) The therapeutic relationship in psychiatric hospital treatment. B Menninger Clin 56(1):4–19Google Scholar
- 46.Brom L, Hopmans W, Pasman RW, Timmermans DR, Widdershoven GA, Onwuteaka-Philipsen BD (2014) Congruence between patients’ preferred and perceived participation in medical decision-making: a review of the literature. BMC Med Inform Decis Mak 14:1–16. https://doi.org/10.1186/1472-6947-14-25 CrossRefGoogle Scholar
- 47.de las Cuevas C, Rivero-Santana A, Perestelo-Perez L, Pérez-Ramos J, Serrano-Aguilar P (2012) Attitudes toward concordance in psychiatry: a comparative, cross-sectional study of psychiatric patients and mental health professionals. BMC Psychiatr 12:1–7. https://doi.org/10.1186/1471-244X-12-53 CrossRefGoogle Scholar
- 48.European Parliament and the Council of the European Union. Additional protocol to the convention on human rights and biomedicine concerning genetic testing for health purposes. 203. 2008. European Treaty Series. No. 203. https://rm.coe.int/1680084824. Accessed 01 May 2019
- 49.United Nations. Committee on the rights of persons with disabilities. Eleventh Session. General comment No. 1. Article 12. (2014). Equal recognition before the law. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html. Accessed 03 Feb 2019