Involuntary treatment in Europe

Abstract

Involuntary treatment is burdened by the lack of evidence. One of the challenges is the difference in practice across borders in Europe. While reviewing the current literature, a proposal of monitoring guidelines is discussed. The field is characterized by a small number of dedicated researchers. A study of violence in first-episode psychosis shows that differences in criteria for involuntary admission lead to different prognosis for the patients. The most recent contributions from the cross-national EUNOMIA study point to great variation across countries, regarding frequencies of involuntary admission as well as outcome. The EUNOMIA study provides suggestions for good quality in involuntary admission. A Cochrane review has examined the evidence of involuntary community treatment compared with standard treatment. The effectiveness of involuntary community treatment is limited. The review concludes that the benefits for a small number of patients are outweighed by the high numbers needed to treat in terms of avoided re-admission. Despite pioneering work, involuntary treatment is still caught up in tradition. There is a lack of standard and proof of effectiveness. A proposal of monitoring guidelines for involuntary measures is a first step to improve the situation.