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Psychiatric Quarterly

, Volume 84, Issue 1, pp 73–80 | Cite as

Impact of Psychiatrists’ Qualifications on the Rate of Compulsory Admissions

  • Ariel EytanEmail author
  • Anne Chatton
  • Edith Safran
  • Yasser Khazaal
Original Paper

Abstract

Despite efforts to reduce coercion in psychiatry, involuntary hospitalizations remain frequent, representing more than half of all admissions in some European regions. Since October 2006, only certified psychiatrists are authorized to require a compulsory admission to our facility, while before all physicians were, including residents. The aim of the present study is to assess the impact of this change of procedure on the proportion compulsory admissions. All medical records of patients admitted respectively 4 months before and 4 month after the implementation of the procedure were retrospectively analyzed. This search retrieved a total of 2,227 hospitalizations for 1,584 patients. The overall proportions of compulsory and voluntary admissions were 63.9 % and 36.1 % respectively. The average length of stay was 32 days (SD ± 64.4). During the study period, 25 % of patients experienced two hospitalizations or more. The most frequent patients’ diagnoses were affective disorders (30 %), psychotic disorders (18.4 %) and substance abuse disorders (15.7 %). Compared with the period before October 2006, patients hospitalized from October 2006 up were less likely to be hospitalized on a compulsory basis (OR = 0.745, 95 % CI: 0.596–0.930). Factors associated with involuntary admission were young age (20 years or less), female gender, a diagnosis of psychotic disorder and being hospitalized for the first time. Our results strongly suggest that limiting the right to require compulsory admissions to fully certified psychiatrists can reduce the rate of compulsory versus voluntary admissions.

Keywords

Compulsory admission Psychiatric hospitalization Restraint Coercion 

References

  1. 1.
    McLachlan AJ, Mulder RT: Criteria for involuntary hospitalisation. Australian and New Zealand Journal of Psychiatry 33(5):729–733, 1999PubMedCrossRefGoogle Scholar
  2. 2.
    Lauber C, Falcato L, Rossler W: Attitudes to compulsory admission in psychiatry. Lancet 355(9220):2080, 2000. doi: 10.1016/S0140-6736(05)73539-X PubMedCrossRefGoogle Scholar
  3. 3.
    Raboch J, Kalisova L, Nawka A, Kitzlerova E, Onchev G, Karastergiou A et al.: Use of coercive measures during involuntary hospitalization: Findings from ten European countries. Psychiatric Services 61(10):1012–1017, 2010. doi: 10.1176/appi.ps.61.10.1012 PubMedCrossRefGoogle Scholar
  4. 4.
    Hansson L, Muus S, Saarento O, Vinding HR, Gostas G, Sandlund M et al.: The nordic comparative study on sectorized psychiatry: Rates of compulsory care and use of compulsory admissions during a 1-year follow-up. Social Psychiatry and Psychiatric Epidemiology 34(2):99–104, 1999PubMedCrossRefGoogle Scholar
  5. 5.
    Wierdsma AI, Mulder CL: Does mental health service integration affect compulsory admissions? The International Journal of Integrated Care 9:e90, 2009Google Scholar
  6. 6.
    Lay B, Nordt C, Rossler W: Variation in use of coercive measures in psychiatric hospitals. European Psychiatry 26(4):244–251, 2011. doi: 10.1016/j.eurpsy.2010.11.007 PubMedCrossRefGoogle Scholar
  7. 7.
    Bhui K, Stansfeld S, Hull S, Priebe S, Mole F, Feder G: Ethnic variations in pathways to and use of specialist mental health services in the UK. Systematic review. The British Journal of Psychiatry 182:105–116, 2003PubMedCrossRefGoogle Scholar
  8. 8.
    van der Post L, Visch I, Mulder C, Schoevers R, Dekker J, Beekman A: Factors associated with higher risks of emergency compulsory admission for immigrants: A report from the ASAP study. International Journal of Social Psychiatry. 2011. doi: 10.1177/0020764011399970
  9. 9.
    de Wit MA, Tuinebreijer WC, van Brussel GH, Selten JP: Ethnic differences in risk of acute compulsory admission in Amsterdam, 1996–2005. Social Psychiatry and Psychiatric Epidemiology. 2010. doi: 10.1007/s00127-010-0312-1
  10. 10.
    Cougnard A, Kalmi E, Desage A, Misdrahi D, Abalan F, Brun-Rousseau H et al.: Factors influencing compulsory admission in first-admitted subjects with psychosis. Social Psychiatry and Psychiatric Epidemiology 39(10):804–809, 2004PubMedGoogle Scholar
  11. 11.
    Montemagni C, Bada A, Castagna F, Frieri T, Rocca G, Scalese M et al.: Predictors of compulsory admission in schizophrenia-spectrum patients: excitement, insight, emotion perception. Progress in Neuro-Psychopharmacology & Biological Psychiatry 35(1):137–145, 2011. doi: 10.1016/j.pnpbp.2010.10.005 CrossRefGoogle Scholar
  12. 12.
    Hattori I, Higashi T: Socioeconomic and familial factors in the involuntary hospitalization of patients with schizophrenia. Psychiatry and Clinical Neurosciences 58(1):8–15, 2004PubMedCrossRefGoogle Scholar
  13. 13.
    Salize HJ, Dressing H: Epidemiology of involuntary placement of mentally ill people across the European Union. The British Journal of Psychiatry 184:163–168, 2004PubMedCrossRefGoogle Scholar
  14. 14.
    Wierdsma AI, Poodt HD, Mulder CL: Effects of community-care networks on psychiatric emergency contacts, hospitalisation and involuntary admission. Journal of Epidemiology and Community Health 61(7):613–618, 2007. doi: 10.1136/jech.2005.044974 PubMedCrossRefGoogle Scholar
  15. 15.
    Henderson C, Flood C, Leese M, Thornicroft G, Sutherby K, Szmukler G: Effect of joint crisis plans on use of compulsory treatment in psychiatry: single blind randomised controlled trial. BMJ 329(7458):136, 2004. doi: 10.1136/bmj.38155.585046.63 PubMedCrossRefGoogle Scholar
  16. 16.
    Khazaal Y, Richard C, Matthieu-Darekar S, Quement B, Kramer U, Preisig M: Advance directives in bipolar disorder, a cognitive behavioural conceptualization. International Journal of Law and Psychiatry 31(1):1–8, 2008. doi: 10.1016/j.ijlp.2007.11.001 PubMedCrossRefGoogle Scholar
  17. 17.
    Khazaal Y, Chatton A, Pasandin N, Zullino D, Preisig M: Advance directives based on cognitive therapy: A way to overcome coercion related problems. Patient Education and Counseling 74(1):35–38, 2009. doi: 10.1016/j.pec.2008.08.006 PubMedCrossRefGoogle Scholar
  18. 18.
    Busino-Salzmann B: Admissions non-volontaires à Genève. Geneva, University of Geneva, 1997Google Scholar
  19. 19.
    Kaufman AR, Way B: North Carolina resident psychiatrists knowledge of the commitment statutes: Do they stray from the legal standard in the hypothetical application of involuntary commitment criteria? Psychiatric Quarterly 81(4):363–367, 2010. doi: 10.1007/s11126-010-9144-0 PubMedCrossRefGoogle Scholar
  20. 20.
    Luchins DJ, Cooper AE, Hanrahan P, Rasinski K: Psychiatrists’ attitudes toward involuntary hospitalization. Psychiatric Services 55(9):1058–1060, 2004. doi: 10.1176/appi.ps.55.9.1058 PubMedCrossRefGoogle Scholar
  21. 21.
    Thompson EE, Neighbors HW, Munday C, Trierweiler S: Length of stay, referral to aftercare, and rehospitalization among psychiatric inpatients. Psychiatric Services 54(9):1271–1276, 2003PubMedCrossRefGoogle Scholar
  22. 22.
    Bobo WV, Hoge CW, Messina MA, Pavlovcic F, Levandowski D, Grieger T: Characteristics of repeat users of an inpatient psychiatry service at a large military tertiary care hospital. Military Medicine 169(8):648–653, 2004PubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2012

Authors and Affiliations

  • Ariel Eytan
    • 1
    Email author
  • Anne Chatton
    • 2
  • Edith Safran
    • 3
  • Yasser Khazaal
    • 2
  1. 1.Division of Prison Psychiatry, Department of Mental Health and PsychiatryUniversity Hospitals of GenevaGenevaSwitzerland
  2. 2.Division of AddictologyUniversity Hospitals of GenevaGenevaSwitzerland
  3. 3.Health-Economic UnitUniversity Hospitals of GenevaGenevaSwitzerland

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