Professionals\u2019 perspectives on factors within primary mental health services that can affect pathways to involuntary psychiatric admissions

Irene Wormdahl,Jorun Rugkåsa,Tonje Lossius Husum,Marit B Rise

doi:10.1186/s13033-020-00417-z

Abstract

BackgroundReducing involuntary psychiatric admissions has beenon the international human rights and health policy agenda for years. Despitethe last decades’ shift towards more services for adults with severe mentalillness being provided in the community, most research on how to reduce involuntaryadmissions has been conducted at secondary health care level. Research from the primary health care level is largely lacking. Theaim of this study was to explore mental health professionals’ experiences withfactors within primary mental health services that might increase the risk of involuntarypsychiatric admissions of adults, and their views on how such admissions mightbe avoided.MethodsQualitative semi-structured interviews with thirty-twomental health professionals from five Norwegian municipalities. Data were analysedaccording to the Systematic Text Condensation method.ResultsWithin primary mental health care professionals experienced that a number of factors could increase the risk of involuntary psychiatric admissions. Insufficient time and flexibility in long-term follow-up, limited resources, none or arbitrary use of crisis plans, lack of tailored housing, few employment opportunities, little diversity in activities offered, limited opportunities for voluntary admissions, inadequate collaboration between services and lack of competence were some of the factors mentioned to increase the risk of involuntary psychiatric admissions. Several suggestions on how involuntary psychiatric admissions might be avoided were put forward.ConclusionsMental health professionals within primary mentalhealth care experienced that their services might play an active part inpreventing the use of involuntary psychiatric admissions, suggesting potentialto facilitate a reduction by intervening at this service level. Healthauthorities’ incentives to reduce involuntary psychiatric admissions should toa greater extent incorporate the primary health care level. Further research isneeded on effective interventions and comprehensive models adapted for thiscare level.

Highlights

Reducing involuntary psychiatric admissions has beenon the international human rights and health policy agenda for years
In Norway, involuntary psychiatric admissions are regulated in the Norwegian Mental Health Care Act §§3-2 and 3-3 [21], and they are effectuated at the secondary care level
During the interviews it became clear that while a few working in sheltered housing could recollect an estimated number of involuntary admissions within their service during the last year, none had the overview over the extent of involuntary admissions in their municipality nor the number of persons involuntarily admitted each year

Summary

Introduction

Reducing involuntary psychiatric admissions has beenon the international human rights and health policy agenda for years. In Norway, as well as internationally, reducing involuntary admissions within mental health care has been on the policy agenda for many years [3,4,5,6]. Despite the policy to reduce involuntary admissions, rates in many countries have increased or been close to constant over the last decades [7]. Norway reports numbers at the high end compared to other Western countries [8] with a rate of 186 per 100 K person 16 years and older in 2018 [9]

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