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Psychiatric patients’ views on why their involuntary hospitalisation was right or wrong: a qualitative study

Abstract

Purpose

To explore involuntary patients’ retrospective views on why their hospitalisation was right or wrong.

Methods

Involuntary patients were recruited from 22 hospitals in England and interviewed in-depth. The study drew on grounded theory and thematic analysis.

Results

Most of the patients felt mentally unwell before admission and out of control during their treatment. Despite these common experiences, three groups of patients with distinct views on their involuntary hospitalisation were identified: those who believed that it was right, those who thought it was wrong and those with ambivalent views. Those with retrospectively positive views believed that hospitalisation ensured that they received treatment, averted further harm and offered them the opportunity to recover in a safe place. They felt that coercion was necessary, as they could not recognise that they needed help when acutely unwell. Those who believed that involuntary admission was wrong thought that their problems could have been managed through less coercive interventions, and experienced hospitalisation as an unjust infringement of their autonomy, posing a permanent threat to their independence. Patients with ambivalent views believed that they needed acute treatment and that hospitalisation averted further harm. Nonetheless, they thought that their problems might have been managed through less coercive community interventions or a shorter voluntary hospitalisation.

Conclusions

The study illustrates why some patients view their involuntary hospitalisation positively, whereas others believe it was wrong. This knowledge could inform the development of interventions to improve patients’ views and treatment experiences.

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Acknowledgments

This study was funded by a Grant from the Department of Health, United Kingdom, Commission number 0230072. The researchers were independent from the funders and the views expressed in the publication are those of the authors and not necessarily those of the Department of Health. The funding source had no role in the study design and conduct of the study, data collection, management, data analysis, data interpretation, or writing of the report and preparation, review or approval of the manuscript. Til Wykes and Diana Rose acknowledge financial support from the National Institute for Health Research (NIHR) Specialist Biomedical Research Centre for Mental Health award to the South London and Maudsley NHS Foundation Trust and the Institute of Psychiatry, King’s College London. We are grateful to the Mental Health Research Network for supporting the project, and to all the interviewed patients and staff of the participating hospitals. We also thank all the researchers involved in data collection.

Conflict of interest

The authors declare that they have no conflict of interest.

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Correspondence to Christina Katsakou.

Appendices

Appendix 1 Why do patients believe that their involuntary hospitalisation was right?

Need for coercive intervention: not recognising problems when unwell

“Positive” group

I was becoming extremely anxious and psychotic, so I did need to be taken into hospital… Once it goes past a certain point, I don’t understand the processing, I don’t understand why I need to go into hospital… so I think I did need to be taken under section because I don’t think I’d have agreed voluntarily… (participant 42)

I think if I’d been voluntary I would have left and it wouldn’t have made me better … I think it was right being sectioned, it has helped in the long run definitely (participant 32)

The main helpful part of the sectioning was to get me back onto treatment. Take me out of the community for a while and get me back on my medication, back on my treatment (participant 6)

At the time I was annoyed, but I do think they did the right thing, looking back now and having flashbacks and the daft things I was doing, but it didn’t seem daft at the time…because I wasn’t well…when you’re like that you don’t think, you think that you’re all right (participant 52)

I needed to be sectioned because when I become high and elated it’s very hard for me to recognise it myself. Probably at these times if I’d been able to take myself voluntarily then that probably would have been a better choice. But the problem is I’m not very good at going voluntarily… people talk about trigger factors, but I can only say I’ve never been really able to recognise that happening (participant 13)

“Ambivalent” group

When I’m ill I don’t normally realise that I’m ill; maybe I didn’t believe I needed treatment… that’s what comes in time …when I realise I was getting things wrong, that’s when I started realising I did need treatment (participant 10)

I suppose looking back on it, it was good that I got put in there because I got put on medication and that I think must be helping me (participant 41)

Averting risk and feeling safe in hospital

“Positive” group

I was threatening to kill my brother’s partner. I’d stabbed her in the chest… I needed to have been [sectioned]. I would have… I would have either killed someone or I would have killed myself (participant 6)

I certainly would have been a serious problem at work. As a school teacher … there would be loads of complaints from parents, and I would have got myself the sack… so I’m glad it [involuntary admission] happened (participant 49)

I was a danger to my family and myself so I had to get admitted to hospital … cos I’d threatened me brother-in-law, so I had to get admitted to hospital for my own safety and for my brother-in-law’s safety (participant 59)

I was glad I was in hospital… I couldn’t be anywhere else at that time… I didn’t think I was well enough to come out… I was scared of going out, frightened” (participant 27)

I wanted to stay [in hospital]. I didn’t want to go home… I was a bit frightened to go out, I got really paranoid and I wouldn’t go out” (participant 5)

“Ambivalent” group

It went on for about a month, and then I said to God ‘I’m going to kill someone soon’…I’m glad I was [sectioned] in a way, ‘cos I was, like, collapsing down the street so I’m glad I was picked up in a way (participant 41)

I suppose yeah [I needed hospital treatment] just ‘cos if I carried on thinking the way I was thinking maybe it would have got worse and maybe I would have started like accusing the wrong people… I suppose [it helped] just in the fact that it gave me time to reflect and think about what was going on (participant 22)

Appendix 2 Why do patients believe that their involuntary hospitalisation was wrong?

Need for non-coercive treatment

“Negative” group

Well, honestly I didn’t think I needed hospital treatment, I felt like if my Community Psychiatric Nurse came to me say twice a day to see how I was doing it would be fine (participant 38)

I wouldn’t have needed a section…I could have been put in another part of the hospital where I wasn’t round people really severely mentally ill, on heroin and whatever else they were on… and I’d have got better ten times quicker (participant 53)

I just needed counselling, someone to talk to about my problems … I take this new medication, my consultant found me the right one just on a one-to-one basis, and it doesn’t have no side effects. If I wouldn’t have gone into hospital and I would have stayed out on a one-to-one basis, like seeing him on the outpatients clinic, then there would have been no problem, but someone along the line made it more complicated (participant 14)

I didn’t want to stay in hospital, I wanted to come home and rest at home… ‘cos if I hadn’t been sectioned I would have been allowed to come out, I could’ve crashed out here and set up something more comfortable… and I could have found out what was going on with my girlfriend…and my life… (participant 11)

On reflection I wasn’t very well at the time and I did need some care, but that could have been done in an entirely different way and I was made much worse by what happened to me. I needed some outpatient care; some drug therapy, that’s all (participant 33)

“Ambivalent” group

I shouldn’t be here, I should be at home, sleeping and listening to my music… I would like to sleep in the room for maybe 2 weeks by myself and then I would be alright (participant 25)

I would have stayed in hospital… I went there voluntary and ended up getting sectioned… I did agree to go to hospital… I probably did need the medication… I’m not too sure why I got sectioned…I don’t think anyone really gave me a proper answer… I think it was the right thing for me to go to hospital… I just think it’s a bit unfair being sectioned… (participant 10)

Unjust infringement of autonomy

“Negative” group

I want to take legal action against the people who did this to me [sectioning] and I would like some compensation because I’ve stopped playing professional cricket due to this and one day I’m playing cricket, next day I go into hospital and then my life stopped (participant 14)

After being sectioned I’ve realised that police can walk in at any time in your own home! It’s MY home! … and drag me out in handcuffs. On top of that, it’s made all the neighbours call me “Mad”. Children in the street are stoning my windows! I’ve been labelled by being dragged out by the police (participant 58)

They never let go of you, and you are perfectly fit but you have to [attend outpatients] because once you were sectioned… It’s a waste of the doctors’ time, it’s a waste of my time and I have to ask a neighbour to take me because it’s an out-of- the-way place to get to (participant 33)

The consultant was saying “You’ve got a medical record and once you’ve got a medical record then I can do anything I like”…and I don’t think it should be based on that at all. It should be assessed on each admission! (participant 48)

“Ambivalent” group

The effect of me being sectioned was catastrophic to myself and my children. Social services had my daughter… they wouldn’t let me know where she was, because I’ve got a mental health problem. My son had absolutely gone ballistic. He was now in hospital. My other daughter was told I wasn’t coming back for six months after also being told that I was running up and down the motorway. She was put through an extreme amount of unnecessary stress. I wasn’t even running up the motorway for a start. That didn’t happen… (participant 45)

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Katsakou, C., Rose, D., Amos, T. et al. Psychiatric patients’ views on why their involuntary hospitalisation was right or wrong: a qualitative study. Soc Psychiatry Psychiatr Epidemiol 47, 1169–1179 (2012). https://doi.org/10.1007/s00127-011-0427-z

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Keywords

  • Commitment of mentally ill
  • Coercion
  • Patient admission
  • Inpatients
  • Qualitative research