Implications of Involuntary Psychiatric Admission

Abstract

Involuntary psychiatric admission is an increasing, widespread practice adopted throughout the world; however, its legal regulation and practice are still under debate, and it is subject to criticism from the human rights point of view. Only a few studies have strictly focused on the outcomes and subsequent treatment implications of this practice. To perform a scoping review of the literature on involuntary psychiatric admission and systematize and summarize its outcomes and implications for adult psychiatric inpatients.Four overarching issues emerged from the studies: a) symptomatological repercussions, b) impacts on treatment before discharge, c) impacts on treatment after discharge, and d) implications on patients' attitudes, behavior, and functioning. The overall evidence suggested correlations between involuntary psychiatric admission and several implications: length of stay, aggressive behavior, occurrence of psychopathologies, uses of coercive measures, psychiatric service activations after discharge, emotive reactions, and quality of life. The proposal presented here is the major involvement of the patient and of all the other actors involved during the entire treatment process to promote a shift from a delegation perspective to a negotiation perspective in the management of involuntary psychiatric admission.

Experiences of coercion amongst involuntary mental health care users in KwaZulu-Natal, South Africa

“…Likely explanations for the high proportion of patients who experienced coercion and threats in our study can be explained by the inclusion of voluntary patients in some studies, diagnostic heterogeneity, different cut-off values and the study setting. Perceived coercion on admission has been significantly associated with involuntary admission in many studies ( 2 , 4 , 19 ). All (100%) of the participants in our study were involuntary compared to 39% in the study from Pakistan ( 13 ), and 22% in the study from Ireland ( 19 ).…”

“…This is in keeping with the two main narratives identified in previous studies. Involuntary admission was either justified or considered to be a complex emotional experience that infringed on patients’ autonomy and freedom of movement ( 2 ).…”

“…Most patients were coerced and threatened when they were admitted involuntarily, with little regard for their participation in the process. Negative admission experiences lead to adverse patient outcomes ( 2 ). Our results highlight the need for shared decision making to improve the doctor patient relationship.…”

“…The use of coercion in psychiatry is controversial because persuading someone to be admitted to a hospital using force or threats infringes on an individual’s right to autonomy and freedom of movement ( 1 , 2 ). Coercion can be formal or informal.…”

“…Possible adverse consequences following an involuntary admission include stigma ( 22 ), a negative therapeutic relationship ( 9 ), poorer quality of life, longer length of hospitalization, increased number of aggressive incidents and dissatisfaction with treatment ( 2 ). Despite the negative experience associated with involuntary admission, mental health laws globally permit coercive admission for the treatment of patients with mental illnesses to restore health and prevent harm to self or others.…”