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Bartl G, Stuart R, Ahmed N, Saunders K, Loizou S, Brady G, Gray H, Grundy A, Jeynes T, Nyikavaranda P, Persaud K, Raad A, Foye U, Simpson A, Johnson S, Lloyd-Evans B. A qualitative meta-synthesis of service users' and carers' experiences of assessment and involuntary hospital admissions under mental health legislations: a five-year update. BMC Psychiatry 2024; 24:476. [PMID: 38937705 PMCID: PMC11209989 DOI: 10.1186/s12888-024-05914-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Accepted: 06/17/2024] [Indexed: 06/29/2024] Open
Abstract
BACKGROUND Compulsory admissions occur in psychiatric hospitals around the world. They result in coercive and sometimes traumatic experiences for service users and carers. Legal and service reforms in various countries are intended to reduce rates of detention and improve service user experience. We aimed to inform policy and service delivery by providing an up-to-date synthesis of qualitative evidence on service users' and carers' experiences of assessment and detention under mental health legislation, updating previous reviews in which we searched for literature published up to 2018. METHODS We searched five bibliographic databases for studies published between January 2018 and March 2023. We identified 24 additional studies reporting qualitative investigations of service users' or carers' experiences of assessment or detention under mental health legislation. A team including researchers with relevant personal experience analysed and synthesised data using a thematic synthesis approach. RESULTS Findings suggest that views on compulsory admissions and assessment varied: many reports highlighted its often negative, traumatic impacts on emotional well-being and self-worth, with fewer accounts of it as an opportunity to access help and support, accompanied by feelings of relief. Experiences of racial discrimination, inequality of access, and dissatisfaction with support before and after hospital stay were more prominent than in our previous reviews. CONCLUSIONS Increasing service user and carer involvement in treatment decisions, provision of timely information at key stages of the admission process, training of key personnel, addressing the issue of discrimination, and investing in community alternatives of inpatient care may contribute to and lead to better overall treatment experiences. PROTOCOL REGISTRATION The study protocol has been registered in the PROSPERO database on 30th May 2023 (CRD42023423439).
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Affiliation(s)
- Gergely Bartl
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Ruth Stuart
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Nafiso Ahmed
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Katherine Saunders
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Sofia Loizou
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Grainne Brady
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Hannah Gray
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Andrew Grundy
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Lived Experience Working Group, University College London, London, UK
| | - Tamar Jeynes
- Lived Experience Working Group, University College London, London, UK
| | - Patrick Nyikavaranda
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Lived Experience Working Group, University College London, London, UK
| | - Karen Persaud
- Lived Experience Working Group, University College London, London, UK
| | - Ari Raad
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
| | - Una Foye
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Alan Simpson
- NIHR Policy Research Unit for Mental Health, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK
| | - Sonia Johnson
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK
- Camden and Islington National Health Service Foundation Trust, London, UK
| | - Brynmor Lloyd-Evans
- NIHR Policy Research Unit for Mental Health, Division of Psychiatry, University College London, London, UK.
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Peters SJ, Schmitz-Buhl M, Zielasek J, Gouzoulis-Mayfrank E. Involuntary psychiatric hospitalisation - differences and similarities between patients detained under the mental health act and according to the legal guardianship legislation. BMC Psychiatry 2024; 24:442. [PMID: 38872132 DOI: 10.1186/s12888-024-05892-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 06/05/2024] [Indexed: 06/15/2024] Open
Abstract
BACKGROUND Involuntary psychiatric hospitalisation occurs under different legal premises. According to German law, detention under the Mental Health Act (MHA) is possible in cases of imminent danger of self-harm or harm to others, while detention according to the legal guardianship legislation (LGL) serves to prevent self-harm if there is considerable but not necessarily imminent danger. This study aims to compare clinical, sociodemographic and environmental socioeconomic differences and similarities between patients hospitalised under either the MHA or LGL. METHODS We conducted a retrospective health records analysis of all involuntarily hospitalised cases in the four psychiatric hospitals of the city of Cologne, Germany, in 2011. Of the 1,773 cases, 87.3% were detained under the MHA of the federal state of North Rhine-Westphalia and 6.4% were hospitalised according to the federal LGL. Another 6.3% of the cases were originally admitted under the MHA, but the legal basis of detention was converted to LGL during the inpatient psychiatric stay (MHA→LGL cases). We compared sociodemographic, clinical, systemic and environmental socioeconomic (ESED) variables of the three groups by means of descriptive statistics. We also trained and tested a machine learning-based algorithm to predict class membership of the involuntary modes of psychiatric inpatient care. RESULTS Cases with an admission under the premises of LGL lived less often on their own, and they were more often retired compared to MHA cases. They more often had received previous outpatient or inpatient treatment than MHA cases, they were more often diagnosed with a psychotic disorder and they lived in neighbourhoods that were on average more socially advantaged. MHA→LGL cases were on average older and more often retired than MHA cases. More often, they had a main diagnosis of an organic mental disorder compared to both MHA and LGL cases. Also, they less often received previous psychiatric inpatient treatment compared to LGL cases. The reason for detention (self-harm or harm to others) did not differ between the three groups. The proportion of LGL and MHA cases differed between the four hospitals. Effect sizes were mostly small and the balanced accuracy of the Random Forest was low. CONCLUSION We found some plausible differences in patient characteristics depending on the legal foundation of the involuntary psychiatric hospitalisation. The differences relate to clinical, sociodemographic and socioeconomical issues. However, the low effect sizes and the limited accuracy of the machine learning models indicate that the investigated variables do not sufficiently explain the respective choice of the legal framework. In addition, we found some indication for possibly different interpretation and handling of the premises of the law in practice. Our findings pose the need for further research in this field.
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Affiliation(s)
- Sönke Johann Peters
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany
- LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany
| | - Mario Schmitz-Buhl
- LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany
| | - Jürgen Zielasek
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany
- Medical Faculty, Heinrich Heine University Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany.
- LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany.
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Oeltjen LK, Schulz M, Heuer I, Knigge G, Nixdorf R, Briel D, Hamer P, Brannath W, Utschakowski J, Mahlke C, Gerhardus A. Effectiveness of a peer-supported crisis intervention to reduce the proportion of compulsory admissions in acute psychiatric crisis interventions in an outreach and outpatient setting: study protocol for an exploratory cluster randomised trial combined with qualitative methods. BMJ Open 2024; 14:e083385. [PMID: 38816053 PMCID: PMC11138285 DOI: 10.1136/bmjopen-2023-083385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2023] [Accepted: 05/09/2024] [Indexed: 06/01/2024] Open
Abstract
INTRODUCTION Compulsory admissions are associated with feelings of fear, humiliation and powerlessness. The number of compulsory admissions in Germany and other high-income countries has increased in recent years. Peer support has been shown to increase the self-efficacy of individuals with mental health conditions in acute crises and to reduce the use of coercive measures in clinical settings. The objective of this study is to reduce the number of compulsory admissions by involving peer support workers (PSWs) in acute mental health crises in outreach and outpatient settings. METHODS AND ANALYSIS This one-year intervention is an exploratory, cluster randomised study. Trained PSWs will join the public crisis intervention services (CIS) in two of five regions (the intervention regions) in the city of Bremen (Germany). PSWs will participate in crisis interventions and aspects of the mental health services. They will be involved in developing and conducting an antistigma training for police officers. The remaining three regions will serve as control regions. All individuals aged 18 and older who experience an acute mental health crisis during the operating hours of the regional CIS in the city of Bremen (around 2000 in previous years) will be included in the study. Semistructured interviews will be conducted with PSWs, 30 patients from control and intervention regions, as well as two focus group discussions with CIS staff. A descriptive comparison between all participants in the intervention and control regions will assess the proportion of compulsory admissions in crisis interventions during the baseline and intervention years, including an analysis of temporal changes. ETHICS AND DISSEMINATION This study was approved by the Ethics Committee of the University of Bremen (file 2022-09) on 20 June 2022. The results will be presented via scientific conferences, scientific journals and communicated to policy-makers and practitioners. TRIAL REGISTRATION NUMBER DRKS00029377.
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Affiliation(s)
- Lena Katharina Oeltjen
- Department of Health Services Research, Institute of Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
| | - Maike Schulz
- Department of Psychiatry and Psychotherapy, Hospital Bremen-Ost, Gesundheit Nord Klinikverbund Bremen gGmbH (GENO), Bremen, Germany
| | - Imke Heuer
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Georg Knigge
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Rebecca Nixdorf
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Denis Briel
- Department of Psychiatry and Psychotherapy, Hospital Bremen-Ost, Gesundheit Nord Klinikverbund Bremen gGmbH (GENO), Bremen, Germany
| | | | - Werner Brannath
- Competence Center for Clinical Trials Bremen, University of Bremen, Bremen, Germany
| | - Jörg Utschakowski
- Department of Mental Health and Addiction, Ministry of Health, Women and Consumer Protection, Bremen, Germany
| | - Candelaria Mahlke
- Department of Psychiatry and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Ansgar Gerhardus
- Department of Health Services Research, Institute of Public Health and Nursing Research, Health Sciences Bremen, University of Bremen, Bremen, Germany
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Liss A. A Dilemma in Coercively Treating a Patient. ACADEMIC PSYCHIATRY : THE JOURNAL OF THE AMERICAN ASSOCIATION OF DIRECTORS OF PSYCHIATRIC RESIDENCY TRAINING AND THE ASSOCIATION FOR ACADEMIC PSYCHIATRY 2023; 47:581-582. [PMID: 37794235 DOI: 10.1007/s40596-023-01884-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/23/2023] [Indexed: 10/06/2023]
Affiliation(s)
- Alison Liss
- Temple University Hospital, Philadelphia, PA, USA.
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Papadopoulou V, Arvaniti A, Kalamara E, Georgaca E, Stylianidis S, Peppou LE, Samakouri M. Outcome of Involuntary Mental Health Assessment in a Psychiatric Department in Greece. Healthcare (Basel) 2023; 11:2977. [PMID: 37998469 PMCID: PMC10671104 DOI: 10.3390/healthcare11222977] [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: 10/05/2023] [Revised: 11/07/2023] [Accepted: 11/15/2023] [Indexed: 11/25/2023] Open
Abstract
Despite their controversiality, involuntary admissions in psychiatric departments remain a central issue in mental health care. The present study aims to identify demographic and clinical factors possibly associated with emergency involuntary psychiatric assessment and its outcome in Greece. This study was carried out in the psychiatric department of the University General Hospital of Alexandroupolis (UGHA) from 1 March 2018 to 28 February 2019. The sample included 191 individuals who had been psychiatrically assessed without their consent following a prosecutorial order. The majority of the involuntary assessments resulted in hospitalization (71%), with 51% of them resulting in involuntary hospitalization. Almost all patients diagnosed with "F20-29 schizophrenia, schizotypal and delusional disorders" were subsequently admitted to the psychiatric department of the UGHA (77 of 81, 66 of them involuntarily). Higher admission rates were recorded among those who had been referred from the Prosecutor's Office of regions that are located far from the psychiatric department of UGHA (Fisher's exact test, p-value = 0.045). In multivariate logistic regression, prior contact with psychiatric services and having an "F20-29 schizophrenia, schizotypal and delusional disorders" diagnosis was statistically significant with admission to the hospital as an outcome variable. Our study suggests an increased risk of involuntary admission among patients with psychosis, patients who had visited a psychiatric service prior to their assessment as well as those living further away from the main psychiatric services of the hospital. Better organization of community psychiatric services in remote places from hospital central services may lead to fewer prosecutorial referrals and coercive measures.
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Affiliation(s)
- Vasiliki Papadopoulou
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (V.P.); (E.K.); (M.S.)
| | - Aikaterini Arvaniti
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (V.P.); (E.K.); (M.S.)
- University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
| | - Eleni Kalamara
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (V.P.); (E.K.); (M.S.)
- European Asylum Support Office (EASO), 1917 Valletta MRS, Malta
| | - Eugenie Georgaca
- School of Psychology, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece;
| | - Stelios Stylianidis
- Department of Psychology, Panteion University of Social Sciences, 17671 Athens, Greece; (S.S.); (L.E.P.)
| | - Lily E. Peppou
- Department of Psychology, Panteion University of Social Sciences, 17671 Athens, Greece; (S.S.); (L.E.P.)
| | - Maria Samakouri
- Department of Psychiatry, Medical School, Democritus University of Thrace, 68100 Alexandroupolis, Greece; (V.P.); (E.K.); (M.S.)
- University General Hospital of Alexandroupolis, 68100 Alexandroupolis, Greece
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Păun RM, Pavel AN, Matei VP, Tudose C. Risk factors for involuntary admission in a Romanian patient sample. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2023; 91:101938. [PMID: 37956559 DOI: 10.1016/j.ijlp.2023.101938] [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: 10/30/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/15/2023]
Abstract
BACKGROUND Involuntary admission is widely used in psychiatry, usually requiring that the patient present an imminent danger to himself or others. Previous studies have established several predictors for involuntary admission, but they have been almost exclusively conducted in Western European or North American countries. By contrast, data on this topic from Eastern European countries is virtually absent. Historically, involuntary admission has been often used as a tool for political repression in Romania before the fall of the communist regime. While there have been significant changes in the legal framework in the last 30 years, there is still no real-world data to build upon. METHODS We analyzed a sample of 177 patients admitted to the "Alexandru Obregia" psychiatric hospital in Bucharest between November 2022 and January 2023, of which 49.7% (88) were involuntary hospitalizations. We collected socio-demographic and clinical data by both by direct interview, and by consulting patient records, attending physicians and relatives. RESULTS Socio-demographic factors predictive for involuntary admission were unemployment, lower income, and urban living. Of the clinical variables analyzed, diagnosis of psychosis or mania on admission carried increased risk of involuntary hospitalization, as did nonadherence to treatment, higher disease severity and aggression. Hospital presentation by police or ambulance carried significant additional risk compared to self-referral. CONCLUSION Certain categories of patients are considerably more likely to be involuntarily hospitalized and there appears to be considerable interrelatedness between the identified risk factors.
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Affiliation(s)
- Radu-Mihai Păun
- Department of Psychiatry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, Bucharest, Romania; "Prof. Dr. Alexandru Obregia" Clinical Psychiatric Hospital, 10-12 Berceni Str, Bucharest, Romania
| | - Alexandru Neculai Pavel
- Department of Psychiatry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, Bucharest, Romania
| | - Valentin Petre Matei
- Department of Psychiatry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, Bucharest, Romania; "Prof. Dr. Alexandru Obregia" Clinical Psychiatric Hospital, 10-12 Berceni Str, Bucharest, Romania.
| | - Cătălina Tudose
- Department of Psychiatry, "Carol Davila" University of Medicine and Pharmacy, 8 Eroii Sanitari Bvd, Bucharest, Romania
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Beysard N, Jaquerod X, Morandi S, Gasser J, Carron PN. Involuntary admissions to the emergency department: a retrospective observational study. Swiss Med Wkly 2023; 153:40063. [PMID: 37190905 DOI: 10.57187/smw.2023.40063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/17/2023] Open
Abstract
AIMS The main objective of this study was to describe patients who were involuntarily admitted to the emergency department of Lausanne University Hospital on involuntary admission in 2018 in terms of age, gender, emergency department length of stay, the motive for involuntary admission, use of psychoactive substances, diagnosis, and destination at emergency department discharge, with or without discontinuation of involuntary admission. METHODS This retrospective, observational, and monocentric study included patients 18 years and older admitted to the emergency department of Lausanne University Hospital on involuntary admission from January 1, 2018, to December 31, 2018. Patients were identified by the Cantonal Medical Office of Vaud. The emergency department length of stay and patient destination on discharge from the emergency department were extracted from the patient flow database, and discharge letters and involuntary admission were extracted from the electronic archiving software. Descriptive statistics were processed by using means and standard deviations for quantitative variables with a normal distribution and median and interquartile range for non-normally distributed data. RESULTS During the study period, 83 patients were admitted on involuntary admission to the emergency department. The majority of the patients were male (58%) with a mean age of 55 (±20) years. The median emergency department length of stay of patients with an involuntary admission was between 9 and 16 hours, depending on whether the involuntary admission was confirmed or discontinued after patient assessment in the emergency department. In comparison, the median emergency department length of stay was 6 hours for patients overall. The two principal diagnoses described were psychiatric (schizophrenia) and mental and behavioural disorders due to psychoactive substance use. Half of the patients on involuntary admission consumed psychoactive substances, primarily alcohol, and had a mean ethanolaemia of 53 (±32) mmol/l. CONCLUSIONS Only a third of patients admitted on involuntary admission saw this measure confirmed after their assessment in the emergency department. Involuntary admissions with admission to the emergency department is used to force patients to be examined by an emergency physician or even a psychiatrist. On-call and primary care physicians seemed to lack the time or resources to set up alternatives to emergency department admissions on involuntary admission, especially in situations in which the involuntary admission was discontinued after an emergency department assessment. This demonstrates the inappropriate use of this measure because a patient cannot be involuntarily hospitalised in an emergency department.
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Affiliation(s)
- Nicolas Beysard
- Emergency Department, Lausanne University Hospital, Lausanne, Switzerland
| | - Xavier Jaquerod
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Stéphane Morandi
- Department of Health and Social Action (DSAS), Cantonal Medical Office, General Directorate for Health of Canton of Vaud, Lausanne, Switzerland
- Service of Community Psychiatry, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Switzerland
| | - Jacques Gasser
- Unit for Research in legal Psychiatry and Psychology, Institute of Forensic Psychiatry, Department of Psychiatry, Lausanne University Hospital, Lausanne, Switzerland
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Huang YC, Kao LT, Liao TH, Chiu CC, Wen HC. Risk factors of involuntary referral by police to ER psychiatric services for patients with a severe mental illness: A GEE analysis. Schizophr Res 2023; 254:68-75. [PMID: 36801516 DOI: 10.1016/j.schres.2023.02.002] [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] [Received: 03/30/2022] [Revised: 02/03/2023] [Accepted: 02/04/2023] [Indexed: 02/17/2023]
Abstract
This study aimed to identify risk factors for involuntary referral by police to emergency room (ER) psychiatric services for community-based patients with a mental illness via a generalized estimating equation (GEE) analysis. The analysis was based on data from the Management Information System of Psychiatric Care (MISPC) system for patients with a severe mental illness in Taipei, Taiwan and registered referral records of the police. Data on 6378 patients aged ≥20 years were used in this study, including 164 patients who were involuntarily referred to the ER by the police and 6214 patients who were not during the period of January 1, 2018 to December 31, 2020. GEEs were utilized to explore possible risk factors of repeated involuntary referral to ER psychiatric services for patients with a severe mental illness. The logistic regressions indicated that patients defined as "severe" according to the Mental Health Act of Taiwan (crude odds ratio (OR): 3.840, 95 % confidence interval (CI): 2.407-6.126), with a disability (crude OR: 3.567, 95 % CI: 1.339-9.501), with two or more family members with a psychiatric disorder (crude OR: 1.598, 95 % CI: 1.002-2.548), with a history of a suicide attempt (crude OR: 25.582, 95 % CI: 17.608-37.167), and with a history of domestic violence (crude OR: 16.141, 95 % CI: 11.539-22.579) were positively associated with involuntary referral to ER psychiatric services. However, age (crude OR: 0.971, 95 % CI: 0.960-0.983) and the MISPC score (crude OR: 0.834, 95 % CI: 0.800-0.869) were inversely associated with involuntary referral to ER psychiatric services. After adjusting for demographics and potential confounders, we found that patients defined as "severe" (Exp (β): 3.236), with a disability (Exp (β): 3.715), with a history of a suicide attempt (Exp (β): 8.706), and with a history of domestic violence (Exp (β): 8.826), as well as age (Exp (β): 0.986) and the MISPC score (Exp (β): 0.902) remained significantly associated with repeated involuntary referral to ER psychiatric services. In conclusion, community-based mentally ill patients with a history of a suicide attempt, with a history of domestic violence, with a severe illness, and with a profound level of disability were highly associated with involuntary referral to ER psychiatric services. We suggest that community mental health case managers identify significant factors associated with involuntary referral to ER psychiatric services to accordingly arrange case management plans.
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Affiliation(s)
- Y C Huang
- Department of Psychiatry, Tri-Service General Hospital, Taipei, Taiwan
| | - L T Kao
- Department of Pharmacy Practice, Tri-Service General Hospital, Taipei, Taiwan; School of Pharmacy, National Defense Medical Center, Taipei, Taiwan; Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan; School of Public Health, National Defense Medical Center, Taipei, Taiwan
| | - T H Liao
- Department of Health, Taipei City Government, Taiwan
| | - C C Chiu
- Taipei City Psychiatric Center, Taipei City Hospital, Taipei, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - H C Wen
- School of Healthcare Administration, College of Management, Taipei Medical University, Taiwan.
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Wu MC, Hung CC, Fang SC, Lee TSH. Change of home visit frequency by public health nurses predicts emergency escorts for psychiatric patients living in the community: A retrospective medical record review. Front Public Health 2023; 11:1066908. [PMID: 36844831 PMCID: PMC9948617 DOI: 10.3389/fpubh.2023.1066908] [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: 10/11/2022] [Accepted: 01/17/2023] [Indexed: 02/11/2023] Open
Abstract
Background Improper or insufficient treatment of mental health illness harms individuals, families, and society. When psychiatric treatment shifts from a hospital-based to a community-based health care system, risk management is essential to the provision of effective care. Objective We examine whether an upgrade in home visit frequency of psychiatric patients as identified by public health nurses can predict the subsequent need for emergency escort services for medical treatment. Design A 2-year retrospective medical record review. Settings A district of New Taipei City in Taiwan. Participants A total of 425 patients with a diagnosed mental health illness cared for through home visits by public health nurses from January 2018 to December 2019. Methods We accessed the Ministry of Health and Welfare's psychiatric care management information system to identify a set of medical records, and analyzed these records using chi-square and regression analyses. Results The analyses indicated that the groups experiencing the greatest need for emergency escort services were: male, 35-49 years old, with a senior high school level of education, without a disability identification card, with a schizophrenia diagnosis, and had been reported by the nurse as having progressed to a serious level. Nurses' increased frequency of home visits (an indicator that the patient's overall condition was worsening) and nurses' reports of increased severity of problems were significant predictors of the need for emergency escort services. Conclusions The nurses' adjustment of visit frequency based on the results of the visit assessment predicts the need for emergency escort services for mental patients. The findings support not only the professional roles and functions of public health nurses, but also the importance of strengthening psychiatric health community support services.
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Affiliation(s)
- Meng-Chieh Wu
- Department of Health Education and Health Promotion, National Taiwan Normal University, Taipei, Taiwan
| | - Chia-Chun Hung
- Continuing Education Master's Program of Addiction Prevention and Treatment, National Taiwan Normal University, Taipei, Taiwan
| | - Su-Chen Fang
- Department of Nursing, Mackay Medical College, New Taipei City, Taiwan
| | - Tony Szu-Hsien Lee
- Department of Health Education and Health Promotion, National Taiwan Normal University, Taipei, Taiwan,Continuing Education Master's Program of Addiction Prevention and Treatment, National Taiwan Normal University, Taipei, Taiwan,*Correspondence: Tony Szu-Hsien Lee ✉
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Schneider M, Back M, Krückl JS, Moeller J, Lang UE, Huber CG. Compulsory psychiatric admissions in the canton of Basel-Stadt between September 2013 and April 2022: Analysis of the cantonal database of the Health Department of Basel-Stadt. Int J Soc Psychiatry 2022:207640221141020. [PMID: 36453089 DOI: 10.1177/00207640221141020] [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] [Indexed: 12/05/2022]
Abstract
BACKGROUND According to federal and cantonal law, persons with an acute mental illness can be admitted to a psychiatric hospital or another suitable institution against their will, when other therapeutic options are not available or have been exhausted. In the canton of Basel-Stadt, this is the responsibility of public health officers employed by the division of Social Medicine of the cantonal Health Department. AIMS This study aims to elucidate which factors influence the decision-making of public health officers regarding compulsory admissions over the period from September 2013 to April 2022 in the canton of Basel-Stadt. METHOD Leveraging comprehensive clinical data from the health department of the canton Basel-Stadt (N = 5,'550), we estimated a mixed effects logistic regression model to identify factors contributing to the decision of public-health officers to compulsorily admit patients, while controlling for potential clustering effects among public health officers. RESULTS The risk for compulsory admissions was most strongly predicted by the presence of potential self-harm. In comparison, while being a strong predictor, potential harm to others played a considerably lesser role. Furthermore, psychiatric syndrome, previous compulsory admissions, and the specific context of evaluation were significant predictors. Finally, we found no meaningful personal bias among public health officers. CONCLUSION The results suggest that public health officers' decision-making regarding compulsory admissions focuses on preventing self-harm and, to a lesser degree, harm to others. This indicates that such measures are only used as a measure of last resort, which is in line with current evidence regarding the detrimental effects of compulsory measures on treatment outcomes in psychiatry. Our findings suggest that all relevant stakeholders, including the police, share this perspective. Decision-making regarding compulsory admissions was mostly free of personal biases, suggesting adherence to shared professional standards by public health officers.
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Affiliation(s)
- Michael Schneider
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Moritz Back
- Health Department of Basel-Stadt, Cantonal Medical Service, Social Medicine, Basel, Switzerland
| | - Jana S Krückl
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Julian Moeller
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland.,Division of Clinical Psychology and Epidemiology, Department of Psychology, University of Basel, Basel, Switzerland
| | - Undine E Lang
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
| | - Christian G Huber
- University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland
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11
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Melvin CL, Barnoux M, Alexander R, Roy A, Devapriam J, Blair R, Tromans S, Shepstone L, Langdon PE. A systematic review of in-patient psychiatric care for people with intellectual disabilities and/or autism: effectiveness, patient safety and experience. BJPsych Open 2022; 8:e187. [PMID: 36268640 PMCID: PMC9634562 DOI: 10.1192/bjo.2022.571] [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: 11/23/2022] Open
Abstract
BACKGROUND An increasing number of children, adolescents and adults with intellectual disabilities and/or autism are being admitted to general psychiatric wards and cared for by general psychiatrists. AIMS The aim of this systematic review was to consider the likely effectiveness of in-patient treatment for this population, and compare and contrast differing models of in-patient care. METHOD A systematic search was completed to identify papers where authors had reported data about the effectiveness of in-patient admissions with reference to one of three domains: treatment effect (e.g. length of stay, clinical outcome, readmission), patient safety (e.g. restrictive practices) and patient experience (e.g. patient or family satisfaction). Where possible, outcomes associated with admission were considered further within the context of differing models of in-patient care (e.g. specialist in-patient services versus general mental health in-patient services). RESULTS A total of 106 studies were included and there was evidence that improvements in mental health, social functioning, behaviour and forensic risk were associated with in-patient admission. There were two main models of in-patient psychiatric care described within the literature: admission to a specialist intellectual disability or general mental health in-patient service. Patients admitted to specialist intellectual disability in-patient services had greater complexity, but there were additional benefits, including fewer out-of-area discharges and lower seclusion rates. CONCLUSIONS There was evidence that admission to in-patient services was associated with improvements in mental health for this population. There was some evidence indicating better outcomes for those admitted to specialist services.
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Affiliation(s)
| | | | - Regi Alexander
- Broadland Clinic and Community Forensic Learning Disability Team, Hertfordshire Partnership University NHS Foundation Trust, UK; and School of Life and Medical Sciences, University of Hertfordshire, UK
| | - Ashok Roy
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK; Centre for Mental Health and Wellbeing Research, University of Warwick, UK; and Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, UK
| | - John Devapriam
- Trust Headquarters, Herefordshire and Worcestershire Health and Care NHS Trust, UK
| | - Robert Blair
- School of Computing Sciences, University of East Anglia, UK
| | - Samuel Tromans
- Adult Learning Disabilities Service, Leicestershire Partnership NHS Trust, UK; and Department of Health Sciences, University of Leicester, UK
| | - Lee Shepstone
- Norwich Medical School, University of East Anglia, UK
| | - Peter E Langdon
- Centre for Educational Development, Appraisal and Research, University of Warwick, UK; Centre for Mental Health and Wellbeing Research, University of Warwick, UK; Brooklands Hospital, Coventry and Warwickshire Partnership NHS Trust, UK; and Research and Development, Herefordshire and Worcestershire Health and Care NHS Trust, UK
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12
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Peters SJ, Schmitz-Buhl M, Karasch O, Zielasek J, Gouzoulis-Mayfrank E. Determinants of compulsory hospitalisation at admission and in the course of inpatient treatment in people with mental disorders-a retrospective analysis of health records of the four psychiatric hospitals of the city of Cologne. BMC Psychiatry 2022; 22:471. [PMID: 35836146 PMCID: PMC9284734 DOI: 10.1186/s12888-022-04107-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND We aimed to identify differences in predictors of involuntary psychiatric hospitalisation depending on whether the inpatient stay was involuntary right from the beginning since admission or changed from voluntary to involuntary in the course of in-patient treatment. METHODS We conducted an analysis of 1,773 mental health records of all cases treated under the Mental Health Act in the city of Cologne in the year 2011. 79.4% cases were admitted involuntarily and 20.6% were initially admitted on their own will and were detained later during the course of in-patient stay. We compared the clinical, sociodemographic, socioeconomic and environmental socioeconomic data (ESED) of the two groups. Finally, we employed two different machine learning decision-tree algorithms, Chi-squared Automatic Interaction Detection (CHAID) and Random Forest. RESULTS Most of the investigated variables did not differ and those with significant differences showed consistently low effect sizes. In the CHAID analysis, the first node split was determined by the hospital the patient was treated at. The diagnosis of a psychotic disorder, an affective disorder, age, and previous outpatient treatment as well as the purchasing power per 100 inhabitants in the living area of the patients also played a role in the model. In the Random Forest, age and the treating hospital had the highest impact on the accuracy and decrease in Gini of the model. However, both models achieved a poor balanced accuracy. Overall, the decision-tree analyses did not yield a solid, causally interpretable prediction model. CONCLUSION Cases with detention at admission and cases with detention in the course of in-patient treatment were largely similar in respect to the investigated variables. Our findings give no indication for possible differential preventive measures against coercion for the two subgroups. There is no need or rationale to differentiate the two subgroups in future studies.
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Affiliation(s)
- Sönke Johann Peters
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany ,grid.411097.a0000 0000 8852 305XUniversity Hospital of Cologne, Cologne, Germany
| | - Mario Schmitz-Buhl
- LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany
| | - Olaf Karasch
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany
| | - Jürgen Zielasek
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne, Germany ,grid.411327.20000 0001 2176 9917Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany
| | - Euphrosyne Gouzoulis-Mayfrank
- LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany. .,LVR Clinics Cologne, Wilhelm-Griesinger-Strasse 23, 51109, Cologne, Germany.
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13
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Hofmann AB, Schmid HM, Hofmann LA, Noboa V, Seifritz E, Vetter S, Egger ST. Impact of Compulsory Admission on Treatment and Outcome: A Propensity Score Matched Analysis. Eur Psychiatry 2022; 65:e6. [PMID: 35040426 PMCID: PMC8853855 DOI: 10.1192/j.eurpsy.2022.4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background Despite multiple ethical issues and little evidence of their efficacy, compulsory admission and treatment are still common psychiatric practice. Therefore, we aimed to assess potential differences in treatment and outcome between voluntarily and compulsorily admitted patients. Methods We extracted clinical data from inpatients treated in an academic hospital in Zurich, Switzerland between January 1, 2013 and December 31, 2019. Observation time started upon the first admission and ended after a one-year follow-up after the last discharge. Several sociodemographic and clinical characteristics, including Health of the Nation Outcome Scales (HoNOS) scores, were retrospectively obtained. We then identified risk factors of compulsory admission using logistic regression in order to perform a widely balanced propensity score matching. Altogether, we compared 4,570 compulsorily and 4,570 voluntarily admitted propensity score-matched patients. Multiple differences between these groups concerning received treatment, coercive measures, clinical parameters, and service use outcomes were detected. Results Upon discharge, compulsorily admitted patients reached a similar HoNOS sum score in a significantly shorter duration of treatment. They were more often admitted for crisis interventions, were prescribed less pharmacologic treatment, and received fewer therapies. During the follow-up, voluntarily admitted patients were readmitted more often, while the time to readmission did not differ. Conclusions Under narrowly set circumstances, compulsory admissions might be helpful to avert and relieve exacerbations of severe psychiatric disorders.
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Affiliation(s)
- Andreas B Hofmann
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Hanna M Schmid
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Lena A Hofmann
- Faculty of Medicine, Department of Forensic Psychiatry, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Vanessa Noboa
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland.,Faculty of Medicine, San Francisco de Quito University, Quito, Ecuador
| | - Erich Seifritz
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Stefan Vetter
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland
| | - Stephan T Egger
- Faculty of Medicine, Department of Psychiatry, Psychotherapy and Psychosomatics, Psychiatric University Hospital, University of Zurich, Zurich, Switzerland.,Faculty of Medicine, Department of Psychiatry, University of Oviedo, Oviedo, Spain
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14
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Sociodemographic, Circumstantial, and Psychopathological Predictors of Involuntary Admission of Patients with Acute Psychosis. PSYCHIATRY INTERNATIONAL 2021. [DOI: 10.3390/psychiatryint2030024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Studies have consistently determined that patients with acute psychosis are more likely to be involuntarily admitted, although few studies examine specific risk factors of involuntary admission (IA) among this patient group. Data from all patients presenting in the psychiatric emergency department (PED) over a period of one year were extracted. Acute psychosis was identified using specific diagnostic criteria. Predictors of IA were determined using logistic regression analysis. Out of 2533 emergency consultations, 597 patients presented with symptoms of acute psychosis, of whom 118 were involuntarily admitted (19.8%). Involuntarily admitted patients were more likely to arrive via police escort (odds ratio (OR) 10.94) or ambulance (OR 2.95), live in a psychiatric residency/nursing home (OR 2.76), report non-adherence to medication (OR 2.39), and were less likely to suffer from (comorbid) substance abuse (OR 0.53). Use of mechanical restraint was significantly associated with IA (OR 13.31). Among psychopathological aspects, aggressiveness was related to the highest risk of IA (OR 6.18), followed by suicidal intent (OR 5.54), disorientation (OR 4.66), tangential thinking (OR 3.95), and suspiciousness (OR 2.80). Patients stating fears were less likely to be involuntarily admitted (OR 0.25). By understanding the surrounding influencing factors, patient care can be improved with the aim of reducing the use of coercion.
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15
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Silva B, Gholam M, Golay P, Bonsack C, Morandi S. Predicting involuntary hospitalization in psychiatry: A machine learning investigation. Eur Psychiatry 2021; 64:e48. [PMID: 34233774 PMCID: PMC8316455 DOI: 10.1192/j.eurpsy.2021.2220] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Coercion in psychiatry is a controversial issue. Identifying its predictors and their interaction using traditional statistical methods is difficult, given the large number of variables involved. The purpose of this study was to use machine-learning (ML) models to identify socio-demographic, clinical and procedural characteristics that predict the use of compulsory admission on a large sample of psychiatric patients. Methods We retrospectively analyzed the routinely collected data of all psychiatric admissions that occurred between 2013 and 2017 in the canton of Vaud, Switzerland (N = 25,584). The main predictors of involuntary hospitalization were identified using two ML algorithms: Classification and Regression Tree (CART) and Random Forests (RFs). Their predictive power was compared with that obtained through traditional logistic regression. Sensitivity analyses were also performed and missing data were imputed through multiple imputation using chain equations. Results The three models achieved similar predictive balanced accuracy, ranging between 68 and 72%. CART showed the lowest predictive power (68%) but the most parsimonious model, allowing to estimate the probability of being involuntarily admitted with only three checks: aggressive behaviors, who referred the patient to hospital and primary diagnosis. The results of CART and RFs on the imputed data were almost identical to those obtained on the original data, confirming the robustness of our models. Conclusions Identifying predictors of coercion is essential to efficiently target the development of professional training, preventive strategies and alternative interventions. ML methodologies could offer new effective tools to achieve this goal, providing accurate but simple models that could be used in clinical practice.
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Affiliation(s)
- Benedetta Silva
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Health and Social Action (DSAS), Cantonal Medical Office, General Directorate for Health of Canton of Vaud, Lausanne, Switzerland
| | - Mehdi Gholam
- Epidemiology and Psychopathology Research Unit, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Ecole Polytechnique Fédérale de Lausanne EPFL, School of Basic Sciences, Institute of Mathematics, Lausanne, Switzerland
| | - Philippe Golay
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,General Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Charles Bonsack
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
| | - Stéphane Morandi
- Community Psychiatry Service, Department of Psychiatry, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Department of Health and Social Action (DSAS), Cantonal Medical Office, General Directorate for Health of Canton of Vaud, Lausanne, Switzerland
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16
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Silva M, Antunes A, Azeredo-Lopes S, Loureiro A, Saraceno B, Caldas-de-Almeida JM, Cardoso G. Factors associated with involuntary psychiatric hospitalization in Portugal. Int J Ment Health Syst 2021; 15:37. [PMID: 33879207 PMCID: PMC8056508 DOI: 10.1186/s13033-021-00460-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Accepted: 04/07/2021] [Indexed: 11/24/2022] Open
Abstract
Background Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012. Methods Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors. Results An increment of involuntary hospitalizations was associated with male gender [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.31; 95%CI 1.06–1.62, p < 0.05], having secondary and higher education [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.45; 95%CI 1.05–2.01, p < 0.05, and exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.89; 95%CI 1.38–2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 2.02; 95%CI 1.59–2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.61; 95%CI 1.21–2.16, p < 0.01, and exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 1.73; 95%CI 1.31–2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.74; 95%CI 0.56–0.99, p < 0.05], having experienced a suicide attempt [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.26; 95%CI 0.15–0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.65; 95%CI 0.49–0.86, p < 0.01, exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.67; 95%CI 0.49–0.90, p < 0.01, and exp(\documentclass[12pt]{minimal}
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\begin{document}$$\widehat{\upbeta }$$\end{document}β^) = 0.67; 95%CI 0.46–0.96, p < 0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively]. Conclusions The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations.
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Affiliation(s)
- Manuela Silva
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal. .,Lisbon Institute of Global Mental Health, Lisbon, Portugal.
| | - Ana Antunes
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | | | - Adriana Loureiro
- Centre of Studies on Geography and Spatial Planning (CEGOT), Faculty of Arts and Humanities, Coimbra, Portugal
| | - Benedetto Saraceno
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - José Miguel Caldas-de-Almeida
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
| | - Graça Cardoso
- Comprehensive Health Research Centre (CHRC), NOVA Medical School, NMS, Universidade Nova de Lisboa, Lisbon, Portugal.,Lisbon Institute of Global Mental Health, Lisbon, Portugal
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17
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Dey S, Mellsop G, Obertova Z, Jenkins M. Sociodemographic and clinical variables associated with discharge under compulsory treatment orders. Australas Psychiatry 2021; 29:163-168. [PMID: 33354991 DOI: 10.1177/1039856220970054] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To document the sociodemographic and clinical variables associated with discharge under compulsory treatment orders in patients with schizophrenia or related disorders. METHOD Information on various sociodemographic and clinical variables were extracted from the clinical files of 349 patients discharged from an adult (age 18-65) inpatient psychiatric unit with diagnoses of schizophrenia or related disorders. Univariate and multiple logistic regression analyses with legal compulsion (compulsory versus voluntary) as outcomes were applied. RESULTS Two hundred of the 349 discharged patients were placed under compulsory treatment orders. In the univariate logistic regression analysis, unemployment, diagnosis of schizophrenia, forensic history, dosage of antipsychotics, prescription and frequency of injectable antipsychotics, polypharmacy and a hospital stay of more than 28 days were associated with compulsory status. Being married or in partnership and living with partner was associated with voluntary status. Multiple regression models respectively confirmed most of these relationships observed in the univariate analyses. CONCLUSION Clarification of the apparent drivers for compulsory treatment may help thoughtful reductions in the use of compulsion.
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Affiliation(s)
| | | | - Zuzana Obertova
- Centre for Forensic Anthropology, University of Western Australia, Crawley, WA, Australia
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18
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Karasch O, Schmitz-Buhl M, Mennicken R, Zielasek J, Gouzoulis-Mayfrank E. Identification of risk factors for involuntary psychiatric hospitalization: using environmental socioeconomic data and methods of machine learning to improve prediction. BMC Psychiatry 2020; 20:401. [PMID: 32770970 PMCID: PMC7414567 DOI: 10.1186/s12888-020-02803-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 07/30/2020] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The purpose of this study was to identify factors associated with a high risk of involuntary psychiatric in-patient hospitalization both on the individual level and on the level of mental health services and the socioeconomic environment that patients live in. METHODS The present study expands on a previous analysis of the health records of 5764 cases admitted as in-patients in the four psychiatric hospitals of the Metropolitan City of Cologne, Germany, in the year 2011 (1773 cases treated under the Mental Health Act and 3991 cases treated voluntarily). Our previous analysis had included medical, sociodemographic and socioeconomic data of every case and used a machine learning-based prediction model employing chi-squared automatic interaction detection (CHAID). Our current analysis attempts to improve the previous one through (1) optimizing the machine learning procedures (use of a different type of decision-tree prediction model (Classification and Regression Trees (CART) and application of hyperparameter tuning (HT)), and (2) the addition of patients' environmental socioeconomic data (ESED) to the data set. RESULTS Compared to our previous analysis, model fit was improved. Main diagnoses of an organic mental or a psychotic disorder (ICD-10 groups F0 and F2), suicidal behavior upon admission, admission outside of regular service hours and absence of outpatient treatment prior to admission were confirmed as powerful predictors of detention. Particularly high risks were shown for (1) patients with an organic mental disorder, specifically if they were retired, admitted outside of regular service hours and lived in assisted housing, (2) patients with suicidal tendencies upon admission who did not suffer from an affective disorder, specifically if it was unclear whether there had been previous suicide attempts, or if the affected person lived in areas with high unemployment rates, and (3) patients with psychosis, specifically those who lived in densely built areas with a large proportion of small or one-person households. CONCLUSIONS Certain psychiatric diagnoses and suicidal tendencies are major risk factors for involuntary psychiatric hospitalization. In addition, service-related and environmental socioeconomic factors contribute to the risk for detention. Identifying modifiable risk factors and particularly vulnerable risk groups should help to develop suitable preventive measures.
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Affiliation(s)
- O. Karasch
- LVR-Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | | | - R. Mennicken
- grid.448793.50000 0004 0382 2632LVR Clinical Group Department, Cologne, and FOM University of Applied Sciences, Essen, Germany
| | - J. Zielasek
- LVR-Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany
| | - E. Gouzoulis-Mayfrank
- LVR-Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109 Cologne (Köln), Germany ,LVR Clinics Cologne, Cologne, Germany
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19
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Walker S, Mackay E, Barnett P, Sheridan Rains L, Leverton M, Dalton-Locke C, Trevillion K, Lloyd-Evans B, Johnson S. Clinical and social factors associated with increased risk for involuntary psychiatric hospitalisation: a systematic review, meta-analysis, and narrative synthesis. Lancet Psychiatry 2019; 6:1039-1053. [PMID: 31777340 PMCID: PMC7029280 DOI: 10.1016/s2215-0366(19)30406-7] [Citation(s) in RCA: 89] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/26/2019] [Accepted: 09/27/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Use of involuntary psychiatric hospitalisation varies widely within and between countries. The factors that place individuals and populations at increased risk of involuntary hospitalisation are unclear, and evidence is needed to understand these disparities and inform development of interventions to reduce involuntary hospitalisation. We did a systematic review, meta-analysis, and narrative synthesis to investigate risk factors at the patient, service, and area level associated with involuntary psychiatric hospitalisation of adults. METHODS We searched MEDLINE, PsycINFO, Embase, and the Cochrane Controlled Clinical Register of Trials from Jan 1, 1983, to Aug 14, 2019, for studies comparing the characteristics of voluntary and involuntary psychiatric inpatients, and studies investigating the characteristics of involuntarily hospitalised individuals in general population samples. We synthesised results using random effects meta-analysis and narrative synthesis. Our review follows Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and is registered on PROSPERO, CRD42018095103. FINDINGS 77 studies were included from 22 countries. Involuntary rather than voluntary hospitalisation was associated with male gender (odds ratio 1·23, 95% CI 1·14-1·32; p<0·0001), single marital status (1·47, 1·18-1·83; p<0·0001), unemployment (1·43, 1·07-1·90; p=0·020), receiving welfare benefits (1·71, 1·28-2·27; p<0·0001), being diagnosed with a psychotic disorder (2·18, 1·95-2·44; p<0·0001) or bipolar disorder (1·48, 1·24-1·76; p<0·0001), and previous involuntary hospitalisation (2·17, 1·62-2·91; p<0·0001). Using narrative synthesis, we found associations between involuntary psychiatric hospitalisation and perceived risk to others, positive symptoms of psychosis, reduced insight into illness, reduced adherence to treatment before hospitalisation, and police involvement in admission. On a population level, some evidence was noted of a positive dose-response relation between area deprivation and involuntary hospitalisation. INTERPRETATION Previous involuntary hospitalisation and diagnosis of a psychotic disorder were factors associated with the greatest risk of involuntary psychiatric hospitalisation. People with these risk factors represent an important target group for preventive interventions, such as crisis planning. Economic deprivation on an individual level and at the population level was associated with increased risk for involuntary hospitalisation. Mechanisms underpinning the risk factors could not be identified using the available evidence. Further research is therefore needed with an integrative approach, which examines clinical, social, and structural factors, alongside qualitative research into clinical decision-making processes and patients' experiences of the detention process. FUNDING Commissioned by the Department of Health and funded by the National Institute of Health Research (NIHR) via the NIHR Mental Health Policy Research Unit.
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Affiliation(s)
- Susan Walker
- Division of Psychiatry, University College London, London, UK; Great Ormond Street Institute of Child Health, University College London, London, UK.
| | - Euan Mackay
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Phoebe Barnett
- Department of Clinical Educational and Health Psychology, Centre for Outcomes Research and Effectiveness, University College London, London, UK
| | - Luke Sheridan Rains
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Monica Leverton
- Division of Psychiatry, University College London, London, UK
| | - Christian Dalton-Locke
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Kylee Trevillion
- National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK; Section of Women's Mental Health, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Brynmor Lloyd-Evans
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
| | - Sonia Johnson
- Division of Psychiatry, University College London, London, UK; National Institute of Health Research Mental Health Policy Research Unit, University College London, London, UK
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Abstract
BACKGROUND An open-door policy may help to reduce conflicts, aggression and containment measures in inpatient psychiatric care. OBJECTIVE A complex intervention was performed including opening the doors of an acute psychiatric ward. The aim was to deescalate conflicts and reduce containment measures. METHODS Along with opening of the doors, several other measures were taken including intensive training of staff in deescalating techniques and nonviolent communication, review and liberalization of rules of the ward, opening of a time-out room and access to a secure garden. RESULTS The open-door policy proved to be feasible and was permanently established. Thereafter, incidents involving aggression decreased but containment measures did not. Overall, the staff appreciated the new concept but considered the opening of the doors to be of minor importance. CONCLUSION The opening of a closed psychiatric ward should be understood as part of a complex, autonomy focused intervention. Other aspects such as sufficient numbers of well-trained staff and structural architectural features of the ward are possibly more important than opening of the doors.
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