Abstract
Involuntary admission (IA) is limited to particular situations in mental health laws to protect patients from unnecessary coercion. China’s first national mental health law has been in effect since 2013; however, the status of IA has not been sufficiently explored. To explore the changing patterns of IA since the clinical application of the IA criteria specified in the new law, an investigation of IA status was undertaken in 14 periods (each period lasting for one month from 05/2013 to 05/2017) in the tertiary specialized psychiatric hospital in Shanghai. The socio-demographic and clinical characteristics of 3733 patients were collected. The differences among IA rates in different periods were compared, and the characteristics of patients who were and were not involuntarily admitted were analysed. Multiple logistic regression analysis was used to clarify the independent variables of IA. The IA rate dramatically decreased after the implementation of the new law, while the overall trend gradually increased. The implementation of the IA risk criteria is effective, but IA is still common in China. The medical factors influencing IA following the implementation of the new law are similar to those in previous studies at home and abroad. Non-medical factors might be the main causes of the high IA rates in Chinese psychiatric institutions.
Highlights
It is a controversial topic because of the infringement on basic human rights and low levels of treatment satisfaction[1,2,3], involuntary hospital admission is still a necessary measure in the management of mentally ill individuals who lack insight[4,5]
The relatively high Involuntary admission (IA) rate was related to the characteristics of Shanghai Mental Health Center (SMHC), which is the only tertiary specialized psychiatric hospital in Shanghai and which provides first aid in psychiatric emergencies
The rate of IA declined sharply once the new legislation came into effect, the vast majority of psychiatric admissions remain involuntary
Summary
It is a controversial topic because of the infringement on basic human rights and low levels of treatment satisfaction[1,2,3], involuntary hospital admission is still a necessary measure in the management of mentally ill individuals who lack insight[4,5]. Given the complex factors involved, such as the need to protect the autonomy of mentally ill individuals, the traditions of China’s mental health services, and other socio-cultural variables, the drafters of the law replaced the broader ‘need for treatment’ criteria with much stricter risk-based criteria. The latter had been pilot-tested in local jurisdictions around China before being included in the national law. The situation since the new law took effect is still unclear
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