Voluntary versus involuntary hospital admission in child and adolescent psychiatry: a German sample

Abstract

Involuntary psychiatric admission is a central issue in mental health care, especially in the treatment of children and adolescents. Its legal regulations do not only differ between European countries, but also on a federal level. Only few studies so far dealt with rates of involuntary admission (RIA), mainly focusing on adults, rather than children and adolescents. None of the studies analyzed this topic in a large cohort. The aim of this regional cross-sectional study was to compare voluntary and involuntary admissions in child and adolescent psychiatry (CAP) regarding personal and admission characteristics. Furthermore, risk factors and predictors of involuntary admission should be identified. A retrospective analysis of hospital admission registers from three major German CAP hospitals over a period of 6 years (2004-2009) was conducted (N = 10,547 inpatients). Group comparisons between involuntarily and voluntarily treated minors and a logistic regression to determine predictors of legal status were performed. Information on harm to self or others prior to the admission, medication and clinical outcome was not available due to data structure. 70.8 % of patients were voluntarily and 29.2 % involuntarily admitted. Both subsamples comprised more males. The RIA decreased consistently over the years, ranging from 25.7 to 32.4 %. The strongest predictor of being admitted involuntarily was suffering from mental retardation (OR = 15.74). Adolescence, substance abuse, psychotic disorders and admission on duty time were also strongly associated (OR > 3). In this first large cohort study on involuntary treatment of children and adolescents in Germany, about every fourth patient was treated involuntarily. Certain personal and disease-related factors increased the risk. Commitment laws and other legal instruments for regulating involuntary placements are inconsistent and a standardized description or systematic analysis is needed. The influence of demographic, institutional variables and care and health services aspects should also be investigated.

A cross-sectional study of experienced coercion in adolescent mental health inpatients

“…Research is increasingly focused on the use, effect, and patient’s perception or experience of coercive treatment forms, but little is published on adolescent patients. Coercion is present in adolescent mental health care: in Norway, 20% of admissions among 16- to 17-year-olds was involuntary [ 1 ], although it was 36.5% in a German sample [ 2 ]. Adolescent inpatients may also be subjected to forced medication or nutrition for treatment purposes, as well as other coercive measures, such as holding, mechanical restraints, seclusion, and medication, in order to prevent harm to people or property.…”

Justifications for coercive care in child and adolescent psychiatry, a content analysis of medical documentation in Sweden

“…With regard to adolescents, it has been reported that psychiatrists in Finland are of the opinion that the criteria for coercive care of minors should be broader than for adults and that coercive care should also be used as a preventive measure [ 21 ]. Two studies of medical records indicate that coercive care was associated with psychotic symptoms, mental retardation, temper tantrums, substance abuse, violent behaviour, and suicide risk [ 22 , 23 ]. In an earlier study from our research group [ 24 ], staff members in child and adolescent psychiatry were asked to describe work situations that contained some sort of ethical consideration.…”

I’m not a diagnosis: Adolescents’ perspectives on user participation and shared decision-making in mental healthcare

“…Then I would rely more on those who worked there. (6) Those who described good experiences with user participation referred to being included. As a result, the treatment was perceived as appropriate.…”