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Oh H, Cho Y, Bae J, Holley LC, Shafer M, Kim K, Lee Y. Impact of statutory revisions to family-petitioned civil commitment in South Korea. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2024; 94:101982. [PMID: 38603975 DOI: 10.1016/j.ijlp.2024.101982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 03/06/2024] [Accepted: 03/08/2024] [Indexed: 04/13/2024]
Abstract
INTRODUCTION This study examined the impact of statutory revisions in 2016 which aimed to enhance procedural justice within the process of civil commitment for persons diagnosed with mental illnesses (PDMI) in South Korea. These changes included requiring that PDMI pose a threat of danger to self or others and the need for treatment simultaneously as criteria for petitioning civil commitment. Additionally, the revision established a public entity to oversee the legitimacy of petitions to involuntarily commit PDMI to inpatient treatment. Despite these statutory changes, families providing care for PDMI still appear to depend on civil commitment as a way to seek respite from care burden, not necessarily to respond to psychiatric emergencies involving dangerousness. This practice seems to be aided by processes within the public entity providing oversight. Due to such barriers we hypothesized that, even after the statutory revision in 2016, PDMI who had been civilly committed following petitions from families will not exhibit elevated dangerousness compared to PDMI who had never been hospitalized during the same period. METHODS Trained interviewers recruited 331 participants self-identified as PDMI from psychiatric rehabilitation agencies in the community and aided them in completing a survey including measures of self-reported hospitalization history, suicidality, and aggression toward others. Participants were classified into four groups: Family-petition committed (FPC) group (n = 30, 9.1%), voluntarily hospitalized (VH) group (n = 34, 10.3%), public-petition committed (PPC) group (n = 31, 9.4%), and never hospitalized (NH) group (n = 236, 71.3%). We conducted logistic regression analyses to compare self-reported dangerousness between groups with the NH group as the reference group. RESULTS In the past 12 months, 43.5% of PDMI participants had self-reported behaviors that may have met the dangerousness criteria for civil commitment. Controlling for confounding factors, the PPC group was 2.96 times and 3.02 times as likely to report suicidal ideation and physical aggression, respectively, compared to the NH group. However, as hypothesized, the FPC group did not differ from the NH group on any indicator of self-reported dangerousness. CONCLUSION The findings were based on cross-sectional correlational data and should not be viewed as conclusive evidence that the 2016 statutory revision is ineffective in preventing family-petitioned civil commitment in cases where dangerousness is not apparent. Nevertheless, these findings encourage further empirical studies that illuminate the etiology of procedural justice in civil commitments petitioned by family members and that assess factors and contexts that promote the consideration of least coercive treatments, rather than resorting to involuntary hospitalization when psychiatric emergencies arise.
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Affiliation(s)
- Hyunsung Oh
- School of Social Work, Arizona State University
| | - Yunhwa Cho
- Korea Disabled People's Development Institute.
| | - Jinyeong Bae
- Department of Social Welfare, Catholic University of Korea
| | | | | | - Kyejung Kim
- Department of Social Welfare, Yonsei University School
| | - Yongpyo Lee
- Department of Social Welfare, Catholic University of Korea
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Aluh DO, Aigbogun O, Ukoha-Kalu BO, Silva M, Grigaitė U, Pedrosa B, Santos-Dias M, Cardoso G, Caldas-de-Almeida JM. Beyond Patient Characteristics: A Narrative Review of Contextual Factors Influencing Involuntary Admissions in Mental Health Care. Healthcare (Basel) 2023; 11:1986. [PMID: 37510426 PMCID: PMC10379438 DOI: 10.3390/healthcare11141986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/29/2023] [Accepted: 07/07/2023] [Indexed: 07/30/2023] Open
Abstract
Variations in the rates of involuntary admission (IA) reflect the influence of unexplained contextual variables that are typically too heterogeneous to be included in systematic reviews. This paper attempts to gather and analyze factors unrelated to the patients that have been linked to IA. The articles included in this review were selected by iteratively searching four electronic databases (PubMed, PsychINFO, EMBASE, and Web of Science). A total of 54 studies from 19 different countries and regions, including 14 European countries, the United States, Canada, China, Vietnam, and Taiwan, were selected. The factors were categorized as service-related factors, impactful events, seasonal and temporal factors, mental health legislation, staff factors, and public attitudes. The factors rarely act in isolation but rather interact and reinforce each other, causing a greater influence on IA. This paper explains how these factors present opportunities for robust and sustainable interventions to reduce IAs. The paper also identifies future directions for research, such as examining the effects of economic recessions. Enhancing global reporting standards is essential to validate future research and support further in-depth studies. The complexity of the factors influencing IA and the implicit role of society suggest that resolving it will require social change.
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Affiliation(s)
- Deborah Oyine Aluh
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Department of Clinical Pharmacy and Pharmacy Management, University of Nigeria Nsukka, Nsukka 410105, Nigeria
| | - Osaro Aigbogun
- Department of Management, Marketing and Digital Business, Curtin University, Miri 98009, Malaysia
| | | | - Manuela Silva
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Ugnė Grigaitė
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Barbara Pedrosa
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Margarida Santos-Dias
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - Graça Cardoso
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
| | - José Miguel Caldas-de-Almeida
- Lisbon Institute of Global Mental Health (LIGMH), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
- Comprehensive Health Research Center (CHRC), NOVA Medical School, NOVA University of Lisbon, 1150-082 Lisboa, Portugal
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Ma HJ, Zheng YC, Shao Y, Xie B. Status and clinical influencing factors of involuntary admission in chinese patients with schizophrenia. BMC Psychiatry 2022; 22:818. [PMID: 36544107 PMCID: PMC9769007 DOI: 10.1186/s12888-022-04480-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Though controversial for its various disadvantages, involuntary admission (IA) is necessary in providing mental health care for patients suffering from schizophrenia in China. This article examines the IA rate in a representative sample, and under which circumstances are these patients more likely to be admitted involuntarily. METHODS Adult patients consecutively admitted to two typical hospitals in Shanghai between 2013 and 2014 with a diagnosis of ICD-10 schizophrenia were included. 2167 patients were included in this study. Sociodemographic and clinical data, as well as personal information of psychiatrists who made risk assessment, were collected. The whole sample was divided into voluntary and involuntary admission groups. Group comparisons were performed with SPSS 17.0, using one-way ANOVA, Wilcoxon rank sum test, Chi-squares and Logistic regression. RESULTS Among 2167 inpatients, the majority (2003, 92.4%) were involuntarily admitted. Clinical features, including age of patients (p < 0.001, OR = 1.037), lacking of insight (p < 0.001, OR = 3.691), were statistically significant for IA. Psychiatrist's age (p < 0.001, OR = 1.042) was independently associated with IA. However, risk behaviors had dramatically affected patients' admission status, of which the strongest predictor of IA was noncompliance with treatment (p < 0.001, OR = 3.597). The areas under the curve of the ROC and accuracy for the regression model were 0.815 and 0.927, respectively. CONCLUSION IA patients account for a major proportion of all those hospitalized with schizophrenia in China. Insights and risk behaviors contributed the most reasons for admission status of patients. This research shed light on necessity of further qualitative studies learning detailed evaluation processes of IA and high-quality interventional studies aiming to limit the performance of IA among patients with schizophrenia.
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Affiliation(s)
- Hua-Jian Ma
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, P. R. China
| | - Yu-Chen Zheng
- grid.16821.3c0000 0004 0368 8293Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030 Shanghai, P. R. China
| | - Yang Shao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, Shanghai, P. R. China.
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 200030, Shanghai, P. R. China.
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Ma HJ, Zheng YC, Xie B, Shao Y. Risk assessment and its influencing factors of involuntary admission in patients with mental disorders in Shanghai, China. Int J Soc Psychiatry 2022; 68:745-753. [PMID: 33860690 DOI: 10.1177/00207640211007154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The 'risk criterion' for involuntary admission (IA) has been adopted by Mental Health Law of the People's Republic of China since 2013. How the new legal regulation influences daily practices in psychiatric institutes are still unclear. AIMS The present study sought to explore the application of risk criterion in IA cases; especially risk assessed by psychiatrists at admission and its influencing factors. METHOD Socio-demographic and clinical data including risk assessment for admission of 3,529 involuntary admitted patients from two typical hospitals in Shanghai from 2013 to 2014 were consecutively collected. Personal information of psychiatrists who made admission assessment was collected separately. RESULTS Among the 3,529 cases, 1,890 (53.6%) were admitted because of actual harmful behaviors to self or others, while 1,639 (46.4%) were admitted with some kinds of risk, but 265 (7.5%) were admitted without any records on risk assessment checklists. Patients who were unemployed, of younger age, single status, diagnosed with schizophrenia were more likely to be admitted without any records on the checklist. Male gender, older age, and lower professional title are influencing factors that psychiatrists made no risk assessment records. CONCLUSIONS The vast majority (92.5%) of risk assessment in IA patients were qualified in our study. In order to protect the legal rights of patients better, operational and reasonable procedures of risk assessment should be developed, such include more detailed rules to IA, systematic training of psychiatrists on IA assessment, mechanism improving doctor-patient relationship, and alternative mental health services for patients and so on.
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Affiliation(s)
- Hua-Jian Ma
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, P. R. China
| | - Yu-Chen Zheng
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, P. R. China
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, P. R. China
| | - Yang Shao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, P. R. China
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5
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Pan YZ, Xie XM, Tang YL, Ng CH, Wang G, Xiang YT. A comparison of aggression between patients with acute schizophrenia and mania presenting to psychiatric emergency services. J Affect Disord 2022; 296:493-497. [PMID: 34653702 DOI: 10.1016/j.jad.2021.09.071] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/05/2021] [Accepted: 09/21/2021] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Aggression is common and challenging in psychiatric emergency departments (PED). However, the prevalence of aggression and its correlates in PED patients are not well documented. This study compared the prevalence of aggression between patients with acute schizophrenia and manic episodes. METHODS In this cross-sectional study, patients at a psychiatric emergency department were assessed with measurements of aggression, psychotic and manic symptoms. RESULTS A total of 4,172 patients were included. The prevalence of aggression was 54.8% (95%CI=53.3%-65.2%) in the whole sample, with 48.0% (95%CI=45.8%-50.1%) in patients with an acute schizophrenia episode, and 61.8% (95%CI=59.8%-63.9%) in patients with a manic episode. Multiple logistic regression analysis revealed that, within the acute schizophrenia episode group, male gender (OR=1.47, P<0.01), involuntary admission (OR=3.61, P<0.01) and more severe manic symptoms (OR=1.30, P<0.01) were significantly associated with aggression. Within the manic episode group, living in Beijing (OR=1.51, P<0.01), unemployment (OR=1.34, P=0.03), involuntary admission (OR=7.93, P<0.01), lower education (OR=0.95, P=0.01) and more severe psychotic symptoms (OR=1.05, P<0.01) were significantly associated with aggression. CONCLUSION In this study, aggression appeared to be more common among patients with a manic episode than those with an acute schizophrenia episode. Considering the significant risk of aggression on psychiatric emergency care, appropriate and effective management of aggression in this population group need to be developed.
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Affiliation(s)
- Yi-Zhu Pan
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiao-Meng Xie
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, USA; Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, USA
| | - Chee H Ng
- Department of Psychiatry, The Melbourne Clinic and St Vincent's Hospital, University of Melbourne, Richmond, Victoria, Australia
| | - Gang Wang
- The National Clinical Research Center for Mental Disorders & Beijing Key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China.
| | - Yu-Tao Xiang
- Unit of Psychiatry, Department of Public Health and Medicinal Administration, & Institute of Translational Medicine, Faculty of Health Sciences, University of Macau, Macao SAR, China; Centre for Cognitive and Brain Sciences, University of Macau, Macao SAR, China.
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Geng F, Jiang F, Conrad R, Liu T, Liu Y, Liu H, Tang YL. Factors Associated With Involuntary Psychiatric Hospitalization of Youths in China Based on a Nationally Representative Sample. Front Psychiatry 2020; 11:607464. [PMID: 33343433 PMCID: PMC7744285 DOI: 10.3389/fpsyt.2020.607464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 11/09/2020] [Indexed: 02/04/2023] Open
Abstract
Objective: This nationally representative sample investigates demographic, diagnostic and clinical features associated with both voluntary and involuntary psychiatric hospitalization among children and adolescents psychiatrically hospitalized in China. Method: As part of an official national survey, 41 provincial tertiary psychiatric hospitals in China were selected. Data from 196 children and adolescents who were discharged from these psychiatric hospitals from March 19 to 31, 2019 were retrieved and analyzed. Results: 1. Psychotic symptoms, depressive symptoms and self-injury/suicide were the most common reasons of admission. Girls were significantly likely to be admitted due to depressive symptoms, whereas boys were more likely to be admitted due to aggressive behaviors. 2. The overall rate of involuntary admission was 32.1% (N = 63). Compared to patients who were admitted voluntarily, those who were admitted involuntarily had lower GAF scores on admission, were older, were more likely to present with psychotic symptoms, manic symptoms or aggressive behavior as primary reason for admission, were less likely to present with depressive symptoms, had a significantly longer length of stay, were more likely to be diagnosed with schizophrenia and were less likely to be diagnosed as depressive disorder. 3. A logistic regression showed that depressive symptom as primary reason for admission was significantly associated with voluntary admission (OR = 0.159, p < 0.001), along with two other factors: age (p < 0.01) and a lower GAF score at admission (p < 0.001) were significantly associated with involuntary admission. Conclusion: The rate of involuntary psychiatric hospitalization among children and adolescents is higher in China than in other regions. Developing more specific and more operational criteria to guide involuntary psychiatric admission for child and adolescent patients is of urgency and great importance to ensure appropriate treatment of these patients and protect their rights.
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Affiliation(s)
- Feng Geng
- Affiliated Psychological Hospital of Anhui Medical University, Hefei, China.,Hefei Fourth People's Hospital, Hefei, China.,Anhui Mental Health Center, Hefei, China.,Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Feng Jiang
- Institute of Health Yangtze River Delta, Shanghai Jiao Tong University, Shanghai, China
| | - Rachel Conrad
- Brigham and Women's Hospital, Boston, MA, United States.,Harvard Medical School Center for Bioethics, Boston, MA, United States
| | - Tingfang Liu
- Institute for Hospital Management of Tsinghua University, Beijing, China
| | - Yuanli Liu
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States.,Mental Health Service Line, Atlanta VA Medical Center, Decatur, GA, United States
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Hotzy F, Marty S, Moetteli S, Theodoridou A, Hoff P, Jaeger M. Involuntary admission of psychiatric patients: Referring physicians' perceptions of competence. Int J Soc Psychiatry 2019; 65:580-588. [PMID: 31379244 DOI: 10.1177/0020764019866226] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Involuntary admissions can be detrimental for patients. Due to legal, ethical and clinical considerations, they are also challenging for referring physicians. Nevertheless, not much is known about the subjective perceptions of those who have to decide whether to conduct an involuntary admission or not. AIMS This study aimed at answering the question whether psychiatrists' perceptions of confidence during psychiatric emergency situations and consecutive involuntary admissions differ from those of physicians without a psychiatric training. METHOD We assessed the professional background and subjective perceptions during psychiatric emergency situations in physicians who executed involuntary admissions to the University Hospital of Psychiatry Zurich. We used one-way analysis of variance (ANOVA) with Bonferroni-adjusted post hoc tests and chi-square tests to compare the responses of 43 psychiatrists with those of 64 other physicians. RESULTS Psychiatrists felt less time constraints compared with non-psychiatric residents. The latter also had more doubts on the necessity of the involuntary admission issued. Psychiatrists considered themselves significantly more experienced in handling psychiatric emergency situations and in handling the criteria for involuntary admissions than other physicians. Psychiatrists and other physicians did not differ in their satisfaction concerning course and results of psychiatric emergency situations which was overall high. About half of all participants felt pressure from third parties. CONCLUSION Psychiatric emergency situations are challenging situations not only for patients but also for the involved physicians. Physicians with a specialized training might be more confident in the handling of psychiatric emergency situations and exertion of involuntary admissions. Non-psychiatric physicians might benefit from specialized training programs.
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Affiliation(s)
- Florian Hotzy
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Silvan Marty
- 2 University of Zurich, Zurich, Switzerland.,3 Psychiatrie Baselland, Liestal, Switzerland
| | - Sonja Moetteli
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Anastasia Theodoridou
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Paul Hoff
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland
| | - Matthias Jaeger
- 1 Department of Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich, Zurich, Switzerland.,3 Psychiatrie Baselland, Liestal, Switzerland
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Ma HJ, Xie B, Shao Y, Huang JJ, Xiao ZP. Changing patterns and influencing factors of involuntary admissions following the implementation of China's mental health law: A 4-year longitudinal investigation. Sci Rep 2019; 9:15252. [PMID: 31649331 PMCID: PMC6813341 DOI: 10.1038/s41598-019-51980-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 10/08/2019] [Indexed: 11/24/2022] Open
Abstract
Involuntary admission (IA) is limited to particular situations in mental health laws to protect patients from unnecessary coercion. China’s first national mental health law has been in effect since 2013; however, the status of IA has not been sufficiently explored. To explore the changing patterns of IA since the clinical application of the IA criteria specified in the new law, an investigation of IA status was undertaken in 14 periods (each period lasting for one month from 05/2013 to 05/2017) in the tertiary specialized psychiatric hospital in Shanghai. The socio-demographic and clinical characteristics of 3733 patients were collected. The differences among IA rates in different periods were compared, and the characteristics of patients who were and were not involuntarily admitted were analysed. Multiple logistic regression analysis was used to clarify the independent variables of IA. The IA rate dramatically decreased after the implementation of the new law, while the overall trend gradually increased. The implementation of the IA risk criteria is effective, but IA is still common in China. The medical factors influencing IA following the implementation of the new law are similar to those in previous studies at home and abroad. Non-medical factors might be the main causes of the high IA rates in Chinese psychiatric institutions.
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Affiliation(s)
- Hua-Jian Ma
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P.R. China
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P.R. China
| | - Yang Shao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P.R. China
| | - Jing-Jing Huang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P.R. China
| | - Ze-Ping Xiao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, 200030, P.R. China.
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Ma H, Shao Y. Commentary: The Implementation of China's Mental Health Law-Defined Risk Criteria for Involuntary Admission: A National Cross-Sectional Study of Involuntarily Hospitalized Patients. Front Psychiatry 2019; 10:121. [PMID: 30914981 PMCID: PMC6422891 DOI: 10.3389/fpsyt.2019.00121] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2018] [Accepted: 02/18/2019] [Indexed: 11/13/2022] Open
Affiliation(s)
- Huajian Ma
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yang Shao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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10
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Jiang F, Zhou H, Rakofsky JJ, Hu L, Liu T, Liu H, Liu Y, Tang YL. The Implementation of China's Mental Health Law-Defined Risk Criteria for Involuntary Admission: A National Cross-Sectional Study of Involuntarily Hospitalized Patients. Front Psychiatry 2018; 9:560. [PMID: 30459656 PMCID: PMC6232607 DOI: 10.3389/fpsyt.2018.00560] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Accepted: 10/17/2018] [Indexed: 12/02/2022] Open
Abstract
Objective: Involuntary admission is one of the most controversial issues in psychiatry in China. This study aimed to examine the implementation of the new risk criteria for involuntary admission, as defined by the new Mental Health Law (MHL), in major psychiatric hospitals; and to explore factors associated with the implementation. Method: We selected 32 psychiatric hospitals in 29 provincial capital cities in mainland China. We included all involuntarily admitted psychiatric inpatients who were discharged from December 25 to 27, 2017. Patients' demographic and clinical data and reasons for admission were retrieved. Hospitals' information was also collected. Multilevel logistic regression was applied to explore factors associated with the implementation. Results: We collected valid data from 814 inpatients. Rates of risk criteria implementation ranged from 7.9 to 88.5% in these hospitals. Only 369 inpatients (45.3%) met the MHL-defined risk criteria. Overall, between 62.2 and 78.5% of the variance in risk criteria implementation was at the patient level, and between 21.5 and 37.8% of the variance was at the hospital level. Patients with higher Global Assessment of Functioning (GAF) scores at admission were less likely to meet the risk criteria (OR 1.02, 95% CI 1.01-1.03). No statistically significant association was found between risk criteria implementation and other patient level or hospital level factors. Conclusion: Our findings show the implementation rate of the MHL's risk criteria overall was low, with only 45.3% of involuntary admissions meeting the MHL-defined criteria. This suggests that some patients' civil rights might have been violated.
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Affiliation(s)
- Feng Jiang
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Huixuan Zhou
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jeffrey J Rakofsky
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Linlin Hu
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Tingfang Liu
- Institute for Hospital Management, Tsinghua University, Beijing, China
| | - Huanzhong Liu
- Department of Psychiatry, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Yuanli Liu
- School of Public Health, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yi-Lang Tang
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States.,Atlanta VA Medical Center, Decatur, GA, United States
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Shaoling Z, Jun W, Graham M, Chen C, Simei Z, Qiguang L, Qun W, Jiansong Z, Xiaoping W. Attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments. Psychiatry Res 2017; 258:283-288. [PMID: 28867405 DOI: 10.1016/j.psychres.2017.08.069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Revised: 06/01/2017] [Accepted: 08/23/2017] [Indexed: 11/16/2022]
Abstract
The aim of this study was to investigate the attitudes of Chinese community members and psychiatrists towards forensic psychiatric assessments. A questionnaire designed to record attitudes toward the current forensic psychiatric assessment procedures and the disposal of mentally ill offenders was developed and distributed via a mobile App. A total of 134 community members and 132 psychiatrists voluntarily completed the questionnaire. Most of responders agreed that the department of public-security has the right to apply for a forensic psychiatric assessment but should not be held solely by that department. Community members were less significantly confident in the validation of forensic psychiatric opinions than were the psychiatrists. A significantly higher proportion of community members than psychiatrists considered that offenders judged Not Criminally Responsible on Account of Mental Disorder (NCRMD) should be punished as would be sane people. In addition, only a minority of responders supported that NCRMD should not be held criminally responsible. Our results indicate that both groups have comments on the current distribution of right of startup of forensic psychiatric assessments. Compared to psychiatrists, community members have lower confidence in the validation of forensic psychiatric assessment and have stricter attitudes toward the disposal of offenders with psychiatric disorders.
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Affiliation(s)
- Zhong Shaoling
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Wang Jun
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Mellsop Graham
- Waikato Clinical Campus, University of Auckland, New Zealand
| | - Chen Chen
- Shanghai Key Laboratory of Forensic Medicine, Institute of Forensic Science, Ministry of Justice, PRC, Shanghai 200063, China
| | - Zhang Simei
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Li Qiguang
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Wang Qun
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Zhou Jiansong
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China
| | - Wang Xiaoping
- Mental Health Institute of the Second Xiangya Hospital, Central South University, National Clinical Research Center on Mental Disorders & National Technology Institute on Mental Disorders. Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China.
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12
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A Cross Cultural Comparison of Attitude of Mental Healthcare Professionals Towards Involuntary Treatment Orders. Psychiatr Q 2017; 88:611-621. [PMID: 27837467 DOI: 10.1007/s11126-016-9479-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The purpose of this study was to investigate East-West cultural attitudes of mental healthcare professionals (MHPs) towards Involuntary Treatment Orders (ITOs) among Taiwan, England, Wales, and New Zealand. Data on Taiwanese MHPs' views of ITO regime were collected from the National Psychiatric Disease Mandatory Assessment and Community Care Review Committee (N = 176). A national survey instrument was designed to assess the level of support for ITOs among senior clinicians and to determine their views on the importance of various factors in decision-making, the mechanisms through which coercion may work, impediments to its use, and its perceived impact on patients and therapeutic relationships. A descriptive analysis was carried out with data presented as appropriate for the distribution and a t-test was used to detect any differences by respondents. Risk reduction was ranked the most important factor in use of ITOs and reasons for discharging an order. Female respondents had higher approval ratings, with 85 % of agreeing that ITOs were of benefit to the therapeutic relationship, assured long-term stability, and increased medication compliance. The results suggest that clinicians decide the use of ITOs largely based on the risk management, both in terms of starting and ending an order. However, the use of ITOs vary which reflected in the practice. Given this variation in the use of enabling legislation, multidisciplinary input in decision-making is an essential safety mechanism.
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13
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Shao Y, Xie B. Approaches to involuntary admission of the mentally ill in the People's Republic of China: changes in legislation from 2002 to 2012. THE JOURNAL OF THE AMERICAN ACADEMY OF PSYCHIATRY AND THE LAW 2015; 43:35-44. [PMID: 25770277 PMCID: PMC4379039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
A systematic analysis of laws on involuntary commitment of mentally ill individuals in China has never been undertaken. In this article, we explore the trajectory of the legislation and discuss the social and cultural factors underlying the changes in the laws. In this description and analysis of the differences and similarities in the current legal framework and procedures for involuntary commitment of the mentally ill across the mental health regulations of seven localities and the National Mental Health Law, one can see a gradual trend toward more stringent legislation during the past 10 years. The compromises, reversals, and circuitous course of the legislative process reflect the difficulties that the government faced in achieving a balance between benefits to society and the individual as it attempted to revamp the delivery of mental health services. The 2012 National Mental Health Law, despite some weaknesses, is an important step toward standardizing the diverse practices in involuntary admission of mentally ill persons in China. Further research on the influence of the National Law on mental health services is clearly needed.
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Affiliation(s)
- Yang Shao
- Dr. Shao is a psychiatrist and Dr. Xie is Medical Director, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Bin Xie
- Dr. Shao is a psychiatrist and Dr. Xie is Medical Director, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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14
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Abstract
The first mental health law of China entered into effect on May 1, 2013. This was the biggest event in the mental health field in China. The present review introduces its legislative process, its main idea, and the principle and essence of formulating this mental health law. Current problems of the law and possible countermeasures are also discussed.
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Affiliation(s)
- Yang Shao
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai 200030, China.
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15
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Shao Y, Wang J, Xie B. WITHDRAWN: The first mental health law of China. Asian J Psychiatr 2014:S1876-2018(14)00244-5. [PMID: 25960308 DOI: 10.1016/j.ajp.2014.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2014] [Accepted: 11/05/2014] [Indexed: 11/16/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published, http://dx.doi.org/10.1016/j.ajp.2014.11.001. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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Affiliation(s)
- Yang Shao
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Jijun Wang
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China
| | - Bin Xie
- Shanghai Mental Health Center, Shanghai Jiaotong University School of Medicine, Shanghai 200030, China.
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16
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Frequency of involuntary admissions and its associations with demographic and clinical characteristics in China. Arch Psychiatr Nurs 2014; 28:272-6. [PMID: 25017561 DOI: 10.1016/j.apnu.2014.04.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 03/20/2014] [Accepted: 04/05/2014] [Indexed: 10/25/2022]
Abstract
Involuntary admissions (IA) continue to be a controversial topic in psychiatry. There have been very few studies investigating the pattern of IA and contributing factors in Chinese psychiatric patients. This study examined the prevalence of IA and its relationships with demographic and clinical characteristics in a large psychiatric institution in Hunan province, China. A consecutively collected sample of 161 psychiatric inpatients was collected. The patients' basic socio-demographic and clinical data including admission types were collected. The frequency of IA was 53.1% in the whole sample. In multiple logistic regression analysis, IA was independently associated with female sex, more recent aggression prior to admission and poorer social function and insight into illness. IA was common in clinical practice in China, and its demographic and clinical correlates are similar to the findings reported from western settings.
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