Abstract
BackgroundThe purpose of our study was to identify predictors of a high risk of involuntary psychiatric in-patient treatment.MethodsWe carried out a detailed analysis of the 1773 mental health records of all the persons treated as in-patients under the PsychKG NRW (Mental Health Act for the state of North Rhine-Westphalia, Germany) in a metropolitan region of Germany (the City of Cologne) in 2011. 3991 mental health records of voluntary in-patients from the same hospitals served as a control group. We extracted medical, sociodemographic and socioeconomic data from these records. Apart from descriptive statistics, we used a prediction model employing chi-squared automatic interaction detection (CHAID).ResultsAmong involuntary patients, organic mental disorders (ICD10: F0) and schizophrenia and other psychotic disorders (ICD10: F2) were overrepresented. Patients treated as in-patients against their will were on average older, they were more often retired and had a migratory background. The Exhaustive CHAID analysis confirmed the main diagnosis to be the strongest predictor of involuntary in-patient psychiatric treatment. Other predictors were the absence of outpatient treatment prior to admission, admission outside of regular service hours and migratory background. The highest risk of involuntary treatment was associated with patients with organic mental disorders (ICD 10: F0) who were married or widowed and patients with non-organic psychotic disorders (ICD10: F2) or mental retardation (ICD10: F7) in combination with a migratory background. Also, referrals from general hospitals were frequently encountered.ConclusionsWe identified modifiable risk factors for involuntary psychiatric in-patient treatment. This implies that preventive measures may be feasible and should be implemented to reduce the rate of involuntary psychiatric in-patient treatment. This may include efforts to establish crisis resolution teams to improve out-patient treatment, train general hospital staff in deescalation techniques, and develop special programs for patients with a migratory background.
Highlights
The purpose of our study was to identify predictors of a high risk of involuntary psychiatric in-patient treatment
We found persons with organic mental illness, intellectual disabilities, psychoses and a comorbidity of addiction and psychosis to be at increased risk for involuntary treatment under the North Rhine-Westphalia Mental Health
Our finding that this group of patients was frequently admitted involuntarily outside regular service hours suggests that this group may benefit from 24 h outreach psychiatric services and more intensive out-patient care to prevent involuntary admissions
Summary
The purpose of our study was to identify predictors of a high risk of involuntary psychiatric in-patient treatment. In order to target preventive interventions, it is important to identify risk factors for coercive measures. On the level of patient-related factors, several clinical, sociodemographic and socioeconomic characteristics may contribute to an increased risk for involuntary psychiatric treatment. Several system factors including the availability and configuration of mental health services, laws and regulations as well as how municipal courts and police services are organized and operate, may modify this risk. Such factors differ largely between countries and regions. It is not surprising that detention rates show a marked variability among and within countries [3,4,5,6]
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