Involuntary Admission Research Articles

Does the gender of emergency physicians have an impact on the prehospital care of psychiatric emergencies? a retrospective cohort analysis

BackgroundPsychiatric emergencies pose a special challenge for emergency physicians. It is known from other areas of medicine that the influence of a doctor’s gender can have an impact on the type of treatment and quality of patient care. However, this has not yet been investigated in the context of prehospital care in psychiatric emergencies.ObjectivesTo identify whether the gender of the prehospital emergency physicians has an influence on the “on-scene” time, treatment strategy and on the potential escalation of interventions for patients with a psychiatric diagnosis.MethodsA retrospective cohort analysis of emergency missions with a psychiatric diagnosis was performed between January 1, 2015 and December 31, 2021 at the Department of Emergency Medicine, Department of Anesthesiology and Intensive Care Medicine, University Hospital Ulm, Germany.Results2882 emergency missions with a psychiatric indication/prehospital psychiatric diagnosis were studied and divided into: intoxication (n = 1343, 46.6%), suicidal behavior (n = 488, 16.9%), exceptional mental situation (n = 282, 9.8%), agitation (n = 262, 9.1%), anxiety and panic disorders (n = 262, 9.1%) and “psychiatric miscellaneous” (n = 245, 8.5%). Inpatient hospitalization occurred in 67.9% (n = 1958) of emergency missions. Of these, 20.3% (n = 392) were admitted directly to a psychiatric hospital. Male emergency physicians had a slightly longer "on-scene" time for psychiatric emergencies than female emergency physicians (p = 0.024). However, the variance in "on-scene" time for all interventions was significantly greater for female emergency physicians than for male emergency physicians (p = 0.025). Male emergency physicians were significantly more likely than their female counterparts to administer intravenous hypnotics in prehospital psychiatric emergencies (p = 0.001). For psychiatric patients who refused medically indicated inpatient psychiatric admission (“involuntary psychiatric admission”), male and female emergency physicians were equally likely to take the required action (p = 0.522). However, male emergency physicians were significantly more likely to administer an intravenous hypnotic to enforce involuntary admission (p = 0.009).ConclusionsSimilar to other medical specialties where the influence of physician gender on patient care is certainly relevant, the gender of prehospital emergency physicians also appears to influence their prehospital management strategy in psychiatric emergencies. The influence of gender is sometimes subtle and limited to specific aspects, such as the administration of hypnotics. Prospective study designs are needed to thoroughly investigate the influence of the gender of the prehospital emergency physician on the quality of care in psychiatric emergencies.Trial registrationThe study was approved by the ethics committee of the University Ulm, Trial-Code No. 110/22 and was prospectively registered in the German Clinical Trials Register (DRKS-ID: DRKS00031237). Patient information was not required for retrospective data analysis.

Determinants of acute psychiatric inpatient length of stay in Ireland.

Ireland has had an historic over-reliance on inpatient mental health care accompanied by poorly resourced community provision. There has been an increasing policy focus on provision of mental health care in the community to facilitate diversion from, or shorten stays in, inpatient care. However, little is known about the determinants of psychiatric inpatient length of stay (LOS) to allow for the targeting of community services. To use a large cross-sectional national dataset to examine the determinants of psychiatric inpatient LOS in the Irish context. Using information on 60,607 discharges from adult acute psychiatric units in Ireland between 2015 and 2019, the study employs both descriptive and regression analysis. Using negative binomial regression models, we control for patient demographic, socioeconomic, and clinical characteristics. In addition, as LOS may be related to provision of non-acute services in the patient area of residence, the analysis also controls for aspects of community service provision. The study finds that longer LOS is associated with older age, being female, and having an involuntary admission. Clinical diagnosis significantly impacts LOS, with diagnoses such as schizophrenia being associated with longer LOS. There is also significant variation in LOS across region of residence, with discharges from some regions staying up to 5days longer. The regional variation observed in inpatient LOS supports the assumption that increased provision of community services diverts or reduces the quantum of care required in inpatient settings. However, without substantive improvement in the community data collected and reported, future planning of mental health services, both community and inpatient, will be substantially curtailed.

Regional Variance of Rates of Involuntary Admission in Switzerland

Identification of predictors that contribute to explaining regional variance of involuntary admission (IA) in Switzerland. Multiple regression analysis including potential predictors and regional rates of IA at the level of utilisation-based care regions. Authorisation to issue involuntary admission, assistance/guardianship, outpatient consultation rate in psychiatric practices, hospitalisation rate and urbanisation are significantly related to regional variation in IA rates. Restrictive regulation of the authority to issue IA and voluntary outpatient psychosocial and administrative support measures can contribute to a reduction in the rates of IA.

Ireland's Mental Health Bill 2024: progress, problems and Procrustean perils.

Ireland's Mental Health Bill 2024 proposes the most significant revision of mental health legislation since the Mental Health Act 2001. To explore the 2024 Bill and provide suggestions for the subsequent Act. Review of the 2024 Bill and related literature. The 2024 Bill proposes useful new definitions (e.g., 'mental disorder', 'treatment') and provisions governing specific practices (e.g., 'physical restraint'). Revision is needed to better provide care and protect rights: (a) proposed treatment criteria for involuntary admission should be retained, but 'risk' criteria deleted; (b) treatment provisions should ensure mental health legislation provides for timely, accountable treatment for all patients; (c) detailed provisions about the content of treatment plans do not belong in primary legislation, which is ill-suited to micro-managing individual care and (d) the Mental Health Commission should be incorporated into the Health Information and Quality Authority. The 2024 Bill proposes useful changes but requires revision, especially for involuntary patients who lack decision-making capacity and decline care, for whom the Assisted Decision-Making (Capacity) Act 2015 does not (and was not designed to) provide solutions. Relying on a convoluted combination of the 2015 Act, Circuit Court and High Court would be legally impossible, clinically impracticable and de facto denial of the rights of people with serious mental illness and their families. The final Act can accord with principles of the 2015 Act without relying on its provisions and should benefit patients and support staff in delivering mental health care that is essential and often life-saving.

The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review

This scoping review examined quantitative research comparing involuntary inpatient groups with voluntary inpatients or other comparator group. Ten themes were identified: patient knowledge of legal status, experienced or perceived coercion, effects on medication use, clinical effects measured on outcome scales, effects on psychiatric readmission, use of restraints and seclusion, effects on suicide and deaths, patient satisfaction, length of stay and carer experiences. The review found that involuntary inpatient admission was associated with harms including increased subjective and objective coercion, increased cost and decreased patient satisfaction. In addition, it found that there may be significant confusion among both voluntary and involuntary patients regarding their legal rights. However, patients admitted on an involuntary basis experienced greater improvements in symptoms and function, possibly due to greater symptom burden prior to admission. Involuntary treatment carries the potential for both benefit and harms that should be acknowledged and mitigated by service providers.

Factors associated with electroconvulsive therapy treatment for adults with serious psychiatric conditions in Australia.

To identify factors associated with receiving electroconvulsive therapy (ECT) for serious psychiatric conditions. Retrospective observational study using hospital administrative data linked with death registrations and outpatient mental health data in New South Wales (NSW), Australia. The cohort included patients admitted with a primary psychiatric diagnosis between 2013 and 2022. The outcome measure was receipt of ECT. Of 94,950 patients, 3465 (3.6%) received ECT. The likelihood of receiving ECT was higher in older (hazard ratio [HR] = 1.03), female (HR = 1.24) patients. Compared to depression, patients with schizophrenia/schizoaffective disorder (HR = 0.79), schizophrenia-related disorders (HR = 0.37), mania (HR = 0.64) and other mood disorders (HR = 0.45) had lower odds of receiving ECT. Patients with depression and one other serious psychiatric condition had higher odds of receiving ECT than depression alone. Bipolar disorder likelihood of ECT did not differ from depression. A higher number of mental health outpatient visits in the prior year and an involuntary index admission with depression were also associated with receiving ECT. Likelihood of receiving ECT increased with year of admission (HR = 1.32), private patient status (HR = 2.06), higher socioeconomic status (HR = 1.09) and being married (HR = 1.25). ECT use for depression and bipolar disorder in NSW aligns with clinical national guidelines. Patients with schizophrenia/schizoaffective, schizophrenia-related disorders, mania and other mood disorders had lower likelihood of ECT than depression, despite ECT being recommended by clinical guidelines for these diagnoses. Variations in ECT were strongly associated with healthcare access, with private patients twice as likely to receive ECT than their public counterparts, suggesting a need to explore ECT accessibility.

Legislation and policy for involuntary mental healthcare across countries in the FOSTREN network: rationale, development of mapping survey and protocol.

Several countries are currently revising or have already revised their mental health laws to align with the global movement to reduce the use of coercive care. No government has yet fully implemented the recommendation of the United Nations Convention on the Rights of Persons with Disabilities (UNCRPD) to eliminate the use of coercion in mental healthcare. Consequently, the international field of mental health law and policy is in a degree of flux. To describe the rationale, development and protocol for a project that will map and examine how mental health laws, policies and service capacity across European countries relate to the use of coercive measures, including involuntary admissions and treatment, restraints and seclusion. This will help to better understand the current situation and explore future directions of policies regarding coercive care. The project is being carried out under the purview of the European Cooperation in Science and Technology (COST) action network, entitled FOSTREN (Fostering and Strengthening Approaches to Reducing Coercion in European Mental Health Services). A multidisciplinary group of experts developed a comprehensive survey assessing mental health laws, policies and service frameworks, based on World Health Organization and UNCRPD recommendations. The survey was piloted in three countries, revised and disseminated to 30 FOSTREN country representatives. The survey will provide data for three strands of work on legislation, policies and service-level context. A comprehensive evaluation will be conducted, drawing on findings from all work packages. The project could inform the development of strategies, interventions and legislation to address gaps and promote compliance with international standards.

A predictive model for readmission within 1-year post-discharge in patients with schizophrenia

BackgroundSchizophrenia is a pervasive and severe mental disorder characterized by significant disability and high rates of recurrence. The persistently high rates of readmission after discharge present a serious challenge and source of stress in treating this population. Early identification of this risk is critical for implementing targeted interventions. The present study aimed to develop an easy-to-use predictive instrument for identifying the risk of readmission within 1-year post-discharge among schizophrenia patients in China.MethodsA prediction model, based on static factors, was developed using data from 247 schizophrenia inpatients admitted to the Mental Health Center in Wuxi, China, from July 1 to December 31, 2020. For internal validation, an additional 106 patients were included. Multivariate Cox regression was applied to identify independent predictors and to create a nomogram for predicting the likelihood of readmission within 1-year post-discharge. The model’s performance in terms of discrimination and calibration was evaluated using bootstrapping with 1000 resamples.ResultsMultivariate cox regression demonstrated that involuntary admission (adjusted hazard ratio [aHR] 4.35, 95% confidence interval [CI] 2.13–8.86), repeat admissions (aHR 3.49, 95% CI 2.08–5.85), the prescription of antipsychotic polypharmacy (aHR 2.16, 95% CI 1.34–3.48), and a course of disease ≥ 20 years (aHR 1.80, 95% CI 1.04–3.12) were independent predictors for the readmission of schizophrenia patients within 1-year post-discharge. The area under the curve (AUC) and concordance index (C-index) of the nomogram constructed from these four factors were 0.820 and 0.780 in the training set, and 0.846 and 0.796 for the validation set, respectively. Furthermore, the calibration curves of the nomogram for both the training and validation sets closely approximated the ideal diagonal line. Additionally, decision curve analyses (DCAs) demonstrated a significantly better net benefit with this model.ConclusionsA nomogram, developed using pre-discharge static factors, was designed to predict the likelihood of readmission within 1-year post-discharge for patients with schizophrenia. This tool may offer clinicians an accurate and effective way for the timely prediction and early management of psychiatric readmissions.

Characterization of Bipolar Disorder I and II: Clinical Features, Comorbidities, and Pharmacological Pattern.

Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition provides precise diagnostic criteria to differentiate between bipolar disorder (BD) type I and II; nevertheless, it can be challenging to come up with the right diagnosis. The aim of this study is to evaluate the sociodemographic differences, clinical features, comorbidities, and pharmacological pattern between patients with BD type I and II. A total of 680 patients with BD type I and II were consecutively recruited to our psychiatry department. A semi-structured interview was used to collect several information. Patients with BD type I were mostly males, single, with a lower current age, and unemployed compared to patients with BD type II. Furthermore, patients with BD type I showed an earlier age at onset and a significant higher prevalence of psychotic and residual symptoms, a higher number of hospitalizations, and involuntary admissions. On the other hand, patients with BD type II were associated with a significant higher prevalence of lifetime suicide attempts, psychiatric comorbidities, and use of alcohol. Finally, antidepressant drugs were prescribed more often to patients with BD type II, while antipsychotics and mood stabilizers were mostly prescribed in patients with BD type I. the differentiation of the 2 nosologic bipolar diagnosis is in line with the current scientific interest, confirming the existence of a markedly different profile between BD type I and II. This differentiation could reduce the heterogeneity of bipolar presentation in research, optimize clinical assessment, and increase the interest in developing more precise and individualized therapeutic strategies, also implementing psychosocial therapies.

Influence of prior contact with community mental health services on first inpatient psychiatric admission for ethnic minorities: Findings from the NOMIAC study.

Research has extensively documented inequalities in inpatient psychiatric care provided to people of minoritized ethnic groups. Nonetheless, the role of their previous engagement with community mental health care has been little studied. We aimed at exploring whether previous clinical care can influence key domains of subsequent psychiatric inpatient care for people of ethnic minorities. We identified patients with a first hospital admission between 2016 and 2022, from a representative, highly diverse, catchment area of Northern Italy, using electronic health data of the NOMIAC study. We aimed at testing the impact of clinical care prior to admission on indicators of poor inpatient care, as identified by a participatory expert panel, that is, compulsory admission, insufficient length of stay, administration of Long-Acting Antipsychotics (LAI) during the last 7 days before discharge. Multiple regression models, predicted and counterfactual proportions and path analyses from generalized structural equations modeling were used to explore the association between belonging to ethnic minorities and these indicators. Among 1,524 participants, 18% were from minoritized ethnic groups. While these were more likely to experience an involuntary admission, regardless of previous care received, they were offered appropriate length of stay if had previous engagement with community mental health care. Both belonging to ethnic minorities and mental health care prior-to-admission were independently associated with early LAI administration. Several ethnic inequalities in inpatient care continue despite previous community mental health care provided. Future research should examine how these disparities translate into clinical outcomes. Nonetheless, there is the need to actively promote equity, improving the quality of inpatient care of minoritized ethnic groups.

Relationship of sociodemographic and clinical characteristics to mechanical restraint used in a psychiatric hospital in Spain.

Coercive measures have been applied in mental health fields throughout history, denying people with mental illness the ability to decide, even though there is increasing evidence that these measures bring few benefits to these individuals. The objective of this study was to analyse the sociodemographic and clinical characteristics most likely associated with the use of mechanical restraints (MRs) in psychiatric hospital settings. This was a descriptive, comparative and analytical cross-sectional study in people with mental disorders who were hospitalized in two hospitals in the Autonomous Valencian Community (Spain). We included a total of 91 participants who completed the Scale to Assess Unawareness of Mental Disorder (SUMD), Positive and Negative Syndrome Scale (PANSS), Barrat's Impulsiveness Scale and the Hamilton Anxiety Scale. The results we collected indicated that the patients most likely to be mechanically restrained were younger people with less awareness of their symptoms and disease, previous admissions to a psychiatric hospital and cohabitation with parents and/or family. In addition, having been admitted involuntarily, previously having had MRs applied, presenting more positive psychotic symptoms and habitual caffeine consumption all predicted the use of MRs. The variables that were able to predict MR were involuntary admission, previous use of MR, the presence of positive psychotic symptoms and caffeine consumption. Evaluation of the sociodemographic and clinical characteristics of patients can help health professionals, especially nurses, to recognize patients who are at risk of requiring MR. This allows mental health practitioners to take these factors into account during interventions or when implementing programmes designed to reduce the use of coercive measures in psychiatric hospital settings. What problem did the study address? Coercive measures have been applied in mental health fields throughout history, with no benefits to these patients. What were the main findings? There are studies that relate some variables to MR in psychiatric settings, but we have been able to find variables capable of predicting MR such as involuntary admission, previous use of MR, the presence of positive psychotic symptoms and caffeine consumption. Where and on whom will the research have an impact? The findings of this study allow for the reduction of MRs in psychiatric units. The sociodemographic and clinical characteristics found to be related to MR will help professionals identify when a patient is admitted in order to use specific interventions aimed at preventing the use of MRs during admission. This is the first study to indicate a relationship between caffeine consumption and the use of MRs. Further studies will be necessary to verify if controlled caffeine supplementation during admission to psychiatric units could become an additional strategy contributing to preventing the application of MR specifically in individuals who habitually consume coffee or caffeine-containing beverages daily. We have adhered to relevant EQUATOR guidelines using the STROBE reporting method. No patient or public contribution.

Coercion in Psychiatry: Exploring the Subjective Experience of Coercion Among Patients in Five Portuguese Psychiatric Departments.

The subjective experience of coercion may have a more significant impact on clinical outcomes than formal coercive measures. This study aimed to investigate the subjective experience of coercion among patients on admission in Portuguese psychiatric departments by assessing their perceived coercion, procedural justice, and negative pressures during admission. The study also investigated whether this subjective experience of coercion changed with time during admission, and the predictors of this change. Validated instruments, including the McArthur Admission Experience Survey (AES) and the Client Assessment of Treatment Scale, were used to collect information from 208 adults admitted to five public psychiatric inpatient departments in rural and urban regions of Portugal. About a third (32.24%, n = 49) of the sample had a legal involuntary admission status, while more than a third of them perceived their admission to be involuntary (40.13%, n = 61). The subjective experience of coercion was significantly higher among people who perceived their admission to be involuntary compared to people who perceived their admission to be voluntary (Median = 10, IQR = 5.5 vs. Median = 3, IQR = 6; p < 0.001). Satisfaction with their care was significantly inversely correlated with the subjective experience of coercion (p < 0.01). The changes in the subjective experience of coercion at the second assessment were predicted by the perceived admission status rather than the legal admission status, and the initial procedural justice (p < 0.05). The study findings highlight the importance of improving procedural justice in psychiatric admissions, regardless of the legal status of admission.

Improving assessment and management of suicide risk among people who inject drugs: A mixed methods study conducted at the Medically Supervised Injecting Centre, Sydney.

People who inject drugs are 13 times more likely to die by suicide than the general population. Guidelines for responding to risk in this population are limited. Harm reduction services attended by people who inject drugs require targeted strategies to address the complexities of suicide risk among this population. Co-design, engaging health professionals and people with lived experience informed the study. Mixed methods were used to understand the experience of managing suicide risk among clients attending the Medically Supervised Injecting Centre (MSIC) in Sydney. A survey was administered to assess staff confidence in managing risk. Focus groups were conducted with health professionals and MSIC clients to explore experiences of suicide management, response and opportunities for improvement. Half (N = 17) the MSIC staff surveyed reported over 10 years' experience working with this population. Confidence in managing suicide risk was low. Three key themes emerged from focus groups (N = 17): (i) Autonomy and the need to involve clients in the assessment process; (ii) Trust between clients and health professionals, and transparency in decision-making; and (iii) System barriers, described by health professionals as inadequate referral pathways for clients in distress, and by clients as negative experiences of care, including involuntary admission and not receiving medication (e.g. methadone). Revised assessment guidelines and a tailored safety plan were developed. These resources are also suitable for other alcohol and other drug services. The challenge in managing suicide risk in harm reduction services is balancing duty of care with staff-client relationships and client engagement.

Patterns of health service use for children with mental disorders in an Australian state population cohort.

The rate of mental health services provided to children and young people is increasing worldwide, including in Australia. The aim of this study was to describe patterns of hospital and ambulatory mental health service use among a large population cohort of adolescents followed from birth, with consideration of variation by age, sex and diagnosis. Characteristics of services provided for children with mental disorder diagnoses between birth and age 17.5 years were ascertained for a population cohort of 85,642 children (52.0% male) born between 2002 and 2005, from 'Admitted Patients', 'Emergency Department' and 'Mental Health Ambulatory' records provided by the New South Wales and Australian Capital Territory Health Departments. A total of 11,205 (~13.1%) children received at least one hospital or ambulatory health occasion of service for a mental health condition in the observation period. More than two-fifths of children with mental disorders had diagnoses spanning multiple categories of disorder over time. Ambulatory services were the most heavily used and the most common point of first contact. The rate of mental health service contact increased with age across all services, and for most categories of mental disorder. Girls were more likely to receive services for mental disorders than boys, but boys generally had an earlier age of first service contact. Finally, 3.1% of children presenting to mental health services experienced involuntary psychiatric inpatient admission. The extent of hospital and ambulatory-based mental healthcare service among children emphasises the need for primary prevention and early intervention.

Factors influencing the level of insight and treatment attitude: a cross-sectional study of 141 elderly patients of major depression in Guangzhou, China.

To explore the insight, treatment attitude, and related influencing factors of hospitalized elderly patients suffering from major depression. A total of 141 hospitalized elderly patients with depression were selected as the research objects. Insight was evaluated by the total score of the Insight and Treatment Attitude questionnaire (ITAQ). The data collected included sociodemographic characteristics, psychiatric symptoms, delirium status, social functioning, social support, suicide risk, and cognitive function. The sample included 74.5% of female patients, and the mean age was 67.53 (sd=7.19) years. The influencing factors of inpatients with depression included alcohol consumption, length of hospitalization, admission types, and the main caregivers (P<0.05). The various factors were further analyzed by linear regression, revealing that the insight and treatment attitude of elderly depressed hospitalized patients were mainly related to the Mini-Mental State Examination (MMSE) (β= 0.225, 95% CI 0.055-0.395, P=0.01), dependent on a caregiver (β=-5.810, 95% CI -8.086~-3.535, P<0.001), the type of admission (involuntary admission) (β=-3.365, 95% CI -5.448~-1.283, P=0.002), Functional Activities Questionnaire (FAQ) (β=-0.156, 95% CI -0.303~-0.010, P=0.037), and length of stay (≤28 days) (β=2.272, 95% CI 0.055~-4.489, P=0.045). The level of insight was affected by cognitive function, involuntary admission, dependent on a caregiver, social function and length of stay. Future studies should focus on cognitive function recovery, observation of admission mode, and self-care ability in elderly patients with depression.

Unsuccessful Presentations for Involuntary Admission to an Irish Approved Centre During 2019 and 2021

Unsuccessful Presentations for Involuntary Admission to an Irish Approved Centre During 2019 and 2021

THE EXERCISE OF PUBLIC HEALTH POWERS IN MENTAL HEALTHCARE - THE IMPACT ON PUBLIC SAFETY

To ensure public safety, most European states have statutory powers enabling a range of compulsory interventions for persons with infectious diseases and mental disorders. The evidence of their meaningfulness in mental health patients is dubious, especially regarding their preventive effect on public safety. To reveal the mental health services' impact on violent offense commissions after discharge from involuntary inpatient care, a retrospective three-case series study was conducted. A scoping literature review was performed to construct the recommendations for practice improvement and further studies. Based on individual clinical expertise, the common issues in delivering involuntary mental healthcare in Latvia are described. To conclude, coercive psychiatric interventions shall be considered as a part of internal security and human rights protection and, therefore, shall be surveilled, in line with communicable diseases. Legal mechanisms (temporary protection against violence, coercive measures of a medical nature) are not effective against persons with severe mental illness and fail to prevent violent incidents. By the time being, during involuntary admission and treatment, the patient is subjected to various safety risks, that are inconsistent with the basic rights or best interests, and thus determines the state's obligation to promote voluntary treatment and provide the least restrictive approach.

¿Hay alguna diferencia entre fumadores y no fumadores ingresados en un hospital psiquiátrico?

Objective: comparing the clinical profile, hospital indicators and psychiatric complications between smokers and non-smokers admitted to a psychiatric hospital. Methodology: this was a cross-sectional epidemiological study of the medical records of 573 patients admitted to a psychiatric hospital that complied with the smokefree law. Descriptive statistics, Fisher’s exact test and Mann-Whitney test was used. Results: of the 573 participants, 48% were smokers. The average age was 42.7 years. Smoking was more prevalent among those diagnosed with psychotic disorders (48.4%), those who used only first-generation antipsychotics (49.4%) and higher dosages of psychotropic drugs. The highest proportions of involuntary or court-ordered admissions occurred among smokers. The average number of attempted escapes, episodes of aggression and procedures to manage them was not high (ranging from 0.2 to 1.3 among smokers and from 0.1 to 0.9 among non-smokers). Conclusion: the data showed that smokers were more resistant to being hospitalized in a smoke-free environment. Although smoking cessation in this population is a challenge, neglecting it means devaluing the lives of people with mental disorders. Nurses and other professionals should be encouraged to discuss the scientific evidence about smoking in the psychiatric population.

Length of hospital stay in involuntary admissions in Greece: a 10-year retrospective observational study

PurposeThe treatment of mental disorders has shifted from inpatient wards to community-based settings in recent years, but some patients may still have to be admitted to inpatient wards, sometimes involuntarily. It is important to maintain the length of hospital stay (LoS) as short as possible while still providing adequate care. The present study aimed to explore the factors associated with the LoS in involuntarily admitted psychiatric patients.MethodsA ten-year retrospective chart review of 332 patients admitted involuntarily to the inpatient psychiatric ward of the General University Hospital of Ioannina, Northwestern Greece, between 2008 and 2017 was conducted.ResultsThe mean LoS was 23.8 (SD = 33.7) days and was relatively stable over the years. Longer-stay hospitalization was associated with schizophrenia-spectrum disorder diagnosis, previous hospitalizations and the use of mechanical restraint, whereas patients in residential care experienced significantly longer LoS (52.6 days) than those living with a caregiver (23.5 days) or alone (19.4 days). Older age at disease onset was associated with shorter LoS, whereas no statistically significant differences were observed with regard to gender.ConclusionWhile some of our findings were in line with recent findings from other countries, others could not be replicated. It seems that multiple factors influence LoS and the identification of these factors could help clinicians and policy makers to design more targeted and cost-effective interventions. The optimization of LoS in involuntary admissions could improve patients’ outcomes and lead to more efficient use of resources.

Dual harm: Violent behaviour to others and self-harm behaviour in adults compulsorily admitted to a Dutch psychiatric hospital

BackgroundVerbal and physical violence in psychiatric hospitals can have harmful consequences for staff members, such as physical injury, traumatisation, and sick leave, and they often accompany involuntary admission. Harm to others may co-occur with self-harm, i.e., dual harm. However, little is known about the association between dual-harm and violent behaviour towards staff members and its clinical outcomes, such as seclusion and rapid tranquilisation after involuntary admission to a psychiatric inpatient unit. MethodA convenience sample of patients admitted involuntarily (N = 384; mean age = 48.03, SD = 19.92) between January 2016 and December 2019 in Western Brabant, the Netherlands, was used to design a retrospective file audit. Distinct harm groups, marked by the presence/absence of self- and/or other-harm, were investigated using multivariate linear regression modelling on the seriousness of violent acts and the total length of admission. Logistic regression analyses were used to study the association between harm groups and the administration of rapid tranquilisation, seclusion, and extended involuntary admissions. ResultsSeveral harm groups were identified, including self-harm only, other-harm only, and dual-harm groups. Psychiatric patients admitted to the hospital because of (the risk of) violence towards others had a higher risk of violent incidents during admission and some restrictive measures. In a subgroup of patients with psychotic disorders, patients with dual harm committed the most serious violent incidents compared to those in the other harm groups. ConclusionDistinct harm groups were identified in a sample of involuntarily admitted patients. In a general adult psychiatric setting, patients at risk for violent behaviour, especially dual-harm patients, should be identified and monitored as part of the risk assessment. Future research is needed to explore more clinical correlates in the proposed distinction between harmful groups and to assess long-term prognosis.