Involuntary hospitalisation: Legislative framework, epidemiology and outcome

Abstract

The involuntary hospitalisation of persons with mental health problems is a controversial issue in the provision of psychiatric care, mainly because its application is often coupled with the need to balance controversial interests: the rights of the patient, public safety and the need for treatment. Over the past few decades, the patients’ movement, but also transition from asylum-type psychiatric care to community psychiatry, has shifted the focus of compulsory admission from the dangerousness and social control of the patient to his/her need for treatment. Against this background, reforms were progressively introduced into the relevant laws of most European countries, which gradually incorporated a number of texts and conventions. However, despite the similarities between such laws, there are still significant differences, which also explain to a certain extent the resulting disparities in the number of involuntary admissions in Europe and overall epidemiology of this phenomenon. Worldwide, the high rates of involuntary admissions appear to be more related with certain variables of the psychiatric care system than with the patients’ characteristics, while the outcome appears to be satisfactory. So far, in Greece the number of involuntary hospitalisations is not recorded nationwide, systematically and reliably. The hitherto absence of systematic research into the subject of involuntary hospitalisation, as well as its determinants, also explains the absence of proposals and interventions to address the problem. However, on the basis of the first results of the Survey of Involuntary Hospitalisations in Athens and other scientific data, it appears that compulsory psychiatric treatment constitutes a first-line therapeutic solution, where the incomplete application of the law and the deficiencies of the mental health system, including its regulating culture and outlook, play a decisive role in the emergence of this issue. Therefore, the co-ordination of good practices, documented experience and ethical standards which should ensure the quality of services provided in a community framework appears to be at this stage an unrealistic endeavour for our country.