Decision making process for compulsory admission: study on a group of psychiatrists from Sardinia (Italy)

Abstract

The aim of the study was to investigate the attitudes in the decision making process for admitting patients compulsorily under the Italian Law 180/78. A group of psychiatrists (n = 81) working in the area of Cagliari (Sardinia, Italy). Three case-vignettes describing different hypothetical clinical situations: 1) a man with depression and psychotic symptoms; 2) a woman with a possible first episode of psychosis; and 3) a man with a history of substance abuse and bipolar disorder. Each vignette was followed by a list of 11 factors reported in the literature as important in the decision to admit compulsorily (current mental state, severity of the disease, dangerousness to self or others, psychiatric history, likely response of the mental state to the medical treatment, age and gender of the patient, owning a home, occupational status, social support available). Psychiatrists were asked: a) whether they would admit the patient compulsorily; and b) to rate 11 factors from the most to the least important in their decision. We obtained responses from 57 psychiatrists (26 males and 31 females). The most important factors for deciding to detain a patient compulsorily were: current mental state, diagnosis, severity of the illness and possible contribution of medical treatment. Perceived dangerousness to self and others was considered the most important factor by 23% of the sample. Our results confirm that, in three different hypothetical situations, there is agreement in the factors perceived as the most important in the decision to admit compulsorily, although their application is highly subjective. The factors correspond to those recommended by the Italian Law 180. The need for protection of the patient or others has an important role in the decision and may take precedence over the current mental state of the patients [corrected].