Variations in Patterns of Compulsory Hospitalisation and in Legal Frameworks: An International Comparative Study

Abstract

Background: Rising rates of involuntary hospitalisation have been reported in England and some other higher income countries, but reasons for this are unclear. We aimed to describe the extent of such variations in involuntary hospitalisation rates, and to investigate the possible influences of differences in legislation, demographics, economics, and healthcare provision. Methods: We compared involuntary hospitalisation rates between 2008 and 2017 for 21 countries across Europe. We also obtained data on national legislation, on demographic and economic factors (including gross domestic product per capita, rates of inequality and poverty, and the percentage of population who are foreign-born, ethnic minorities, and/or living in urban settings), and service characteristics (including healthcare spending and rates of psychiatric beds and mental health staff). Findings: The median rate of involuntary hospitalisation was 112.5 (IQR 65.9 to 139.0) per 100,00 population with Austria the highest (282) and Italy the lowest (14.8). Higher national rates of involuntary hospitalisation were associated with a larger number of beds (coefficient: 0.57, 95% CI 0.07 1.06, p=0.0245) and a lower rate of absolute poverty (coefficient: -17.0, 95% CI -29.8, -4.2, p=0.0092). There was no evidence for an association between involuntary hospitalisation rate and any other demographic, economic, or healthcare indicator, nor did we observe any relationship between involuntary hospitalisation rates and characteristics of the legal framework. Interpretation: Countries with a lower rate of absolute poverty and higher numbers of inpatient beds tend to have higher rates of involuntary hospitalisation, though limitations in ecological observations must be noted. Current evidence suggests that demographics, economics, and healthcare provision appear to be more important for understanding differences in rates of involuntary hospitalisation internationally than differences in legislation. Funding Statement: This paper is based on independent research commissioned and funded by the National Institute for Health Research (NIHR) Policy Research Programme. Declaration of Interests: None