Skip to main content
×
×
Home

Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study

  • Michael Lebenbaum (a1), Maria Chiu (a2), Simone Vigod (a3) and Paul Kurdyak (a4)
Abstract
Background

Involuntary admissions to psychiatric hospitals are common; however, research examining the trends in prevalence over time and predictors is limited.

Aims

To examine trends in prevalence and risk factors for involuntary admissions in Ontario, Canada.

Method

We conducted an analysis of all mental health bed admissions from 2009 to 2013 and assessed the association between patient sociodemographics, service utilisation, pathway to care and severity characteristics for involuntary admissions using a modified Poisson regression.

Results

We found a high and increasing prevalence of involuntary admissions (70.7% in 2009, 77.1% in 2013, 74.1% overall). Individuals with police contact in the prior week (risk ratio (RR) = 1.20) and immigrants both experienced greater likelihood of being involuntarily admitted, regardless of control for other characteristics (RR = 1.07) (both P < 0.0001).

Conclusions

We identified numerous modifiable and non-modifiable risk factors for involuntary admissions. The prevalence of involuntary admissions was high, linearly increasing over time.

Declaration of interest

The authors have completed the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported. This study was conducted using funding entirely from public sources. P.K. has received operational support via an Ontario Ministry of Health and Long-Term Care (MOHLTC) Health Services Research Fund Capacity Award to support this project. The Institute for Clinical Evaluative Sciences (ICES) is funded by the Ontario MOHLTC. The study results and conclusions are those of the authors, and should not be attributed to any of the funding agencies or sponsoring agencies. No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred. All decisions regarding study design, publication, and data analysis were made independent of the funding agencies.

  • View HTML
    • Send article to Kindle

      To send this article to your Kindle, first ensure no-reply@cambridge.org is added to your Approved Personal Document E-mail List under your Personal Document Settings on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part of your Kindle email address below. Find out more about sending to your Kindle. Find out more about sending to your Kindle.

      Note you can select to send to either the @free.kindle.com or @kindle.com variations. ‘@free.kindle.com’ emails are free but can only be sent to your device when it is connected to wi-fi. ‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.

      Find out more about the Kindle Personal Document Service.

      Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study
      Available formats
      ×
      Send article to Dropbox

      To send this article to your Dropbox account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Dropbox.

      Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study
      Available formats
      ×
      Send article to Google Drive

      To send this article to your Google Drive account, please select one or more formats and confirm that you agree to abide by our usage policies. If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your <service> account. Find out more about sending content to Google Drive.

      Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study
      Available formats
      ×
Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivatives licence (http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is unaltered and is properly cited. The written permission of Cambridge University Press must be obtained for commercial re-use or in order to create a derivative work.
Corresponding author
Correspondence: Michael Lebenbaum, Mental Health and Addictions Program, ICES, G-106, 2075 Bayview Avenue, Toronto, ON M4N 3M5, Canada. Email: michael.lebenbaum@ices.on.ca
References
Hide All
1 Newton-Howes, G. Coercion in psychiatric care: where are we now, what do we know, where do we go? Psychiatrist 2010; 34: 217–20.
2 Kallert, TW, Glöckner, M, Schützwohl, M. Involuntary vs. voluntary hospital admission. A systematic literature review on outcome diversity. Eur Arch Psychiatry Clin Neurosci 2008; 258: 195209.
3 Priebe, S, Katsakou, C, Glöckner, M, Dembinskas, A, Fiorillo, A, Karastergiou, A, et al. Patients’ views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries. Br J Psychiatry 2010; 196: 179–85.
4 Keown, P, Mercer, G, Scott, J. Retrospective analysis of hospital episode statistics, involuntary admissions under the Mental Health Act 1983, and number of psychiatric beds in England 1996–2006. BMJ 2008; 337: a1837.
5 Priebe, S, Badesconyi, A, Fioritti, A, Hansson, L, Kilian, R, Torres-Gonzales, F, et al. Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. BMJ 2005; 330: 123–6.
6 CL, Mulder, Uitenbroek, D, Broer, J, Lendemeijer, B, van Veldhuizen, JR, van Tilburg, W, et al. Changing patterns in emergency involuntary admissions in the Netherlands in the period 2000–2004. Int J Law Psychiatry 2008; 31: 331–6.
7 Morgan, C, Mallett, R, Hutchinson, G, Bagalkote, H, Morgan, K, Fearon, P, et al. Pathways to care and ethnicity. 1: Sample characteristics and compulsory admission. Report from the AESOP study. Br J Psychiatry 2005; 186: 281–9.
8 Mulder, CL, Koopmans, GT, Selten, JP. Emergency psychiatry, compulsory admissions and clinical presentation among immigrants to the Netherlands. Br J Psychiatry 2006; 188: 386–91.
9 van der Post, L, Mulder, CL, Bernardt, CM, Schoevers, RA, Beekman, AT, Dekker, J. Involuntary admission of emergency psychiatric patients: report from the Amsterdam Study of Acute Psychiatry. Psychiatr Serv 2009; 60: 1543–6.
10 van der Post, L, Visch, I, Mulder, C, Schoevers, R, Dekker, J, Beekman, A. Factors associated with higher risks of emergency compulsory admission for immigrants: a report from the ASAP study. Int J Soc Psychiatry 2012; 58: 374–80.
11 Davies, S, Thornicroft, G, Leese, M, Higgingbotham, A, Phelan, M. Ethnic differences in risk of compulsory psychiatric admission among representative cases of psychosis in London. BMJ 1996; 312: 533–7.
12 Segal, SP, Laurie, TA, Segal, MJ. Factors in the use of coercive retention in civil commitment evaluations in psychiatric emergency services. Psychiatr Serv 2001; 52: 514–20.
13 McGarvey, EL, Leon-Verdin, M, Wanchek, TN, Bonnie, RJ. Decisions to initiate involuntary commitment: the role of intensive community services and other factors. Psychiatr Serv 2013; 64: 120–6.
14 Riley, R, Richman, A. Involuntary hospitalization in Canadian psychiatric inpatient facilities, 1970–1978. Can J Psychiatry 1983; 28: 536–41.
15 Archie, S, Akhtar-Danesh, N, Norman, R, Malla, A, Roy, P, Zipursky, RB. Ethnic diversity and pathways to care for a first episode of psychosis in Ontario. Schizophr Bull 2010; 36: 688701.
16 Bagby, RM. The effects of legislative reform on admission rates to psychiatric units of general hospitals. Int J Law Psychiatry 1987; 10: 383–94.
17 Bagby, RM, Silverman, I, Ryan, DP, Dickens, SE. Effects of mental health legislative reform in Ontario. Can Psychol 1987; 29: 21–9.
18 Malla, A, Norman, RM, Helmes, E. Factors associated with involuntary admission to psychiatric facilities in Newfoundland. CMAJ 1987; 136: 1166–71.
19 Malla, A, Norman, RM. Involuntary admissions in a Canadian province: the influence of geographic and population factors. Soc Psychiatry Psychiatr Epidemiol 1988; 23: 247–51.
20 Crisanti, AS, Love, EJ. Characteristics of psychiatric inpatients detained under civil commitment legislation: a Canadian study. Int J Law Psychiatry 2001; 24: 399410.
21 Tremblay, PF, King, PR, Baines, GR. Clinical and demographic characteristics of voluntary and involuntary psychiatric inpatients. Can J Psychiatry 1994; 39: 297–9.
22 Ontario Hospital Association. A Practical Guide to Mental Health and the Law in Ontario. 2012.
23 Steele, LS, Glazier, RH, Lin, E, Evans, M. Using administrative data to measure ambulatory mental health service provision in primary care. Med Care 2004; 42: 960–5.
24 Atzema, CL, Schull, MJ, Kurdyak, P, Menezes, NM, Wilton, AS, Vermuelen, MJ, et al. Wait times in the emergency department for patients with mental illness. Can Med Assoc J 2012; 184: E969E976.
25 interRAI. Scales: Status and Outcome Measures, 2017 (http://www.interrai.org/scales.html).
26 Martin, BA, Cheung, KD. Civil commitment trends in Ontario: the effect of legislation on clinical practice. Can J Psychiatry 1985; 30: 259–64.
27 Czukar, G, O'Brien, DD. Mental Health Law in Ontario: An Overview - Final Report. 2013.
28 Hartford, K, Schrecker, T, Wiktorowicz, M, Hoch, JS, Sharp, C. Report: four decades of mental health policy in Ontario, Canada. Adm Policy Ment Health Ment Health Serv Res 2003; 31: 6573.
29 Government of Ontario. News Release: Ontario Investing $28 Million in Mental Health and Addictions Services, 2015 (https://news.ontario.ca/mohltc/en/2015/02/ontario-investing-28-million-in-mental-health-and-addictions-services.html).
30 Keown, P, Weich, S, Bhui, KS, Scott, J. Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988–2008: ecological study. BMJ 2011; 343: d3736.
31 Lamb, HR, Weinberger, LE, DeCuir, WJ. The police and mental health. Psychiatr Serv 2002; 53: 1266–71.
32 Laura Kane. In crisis: Why are police apprehending more mentally ill people? 2014 (https://www.thestar.com/news/gta/2014/06/01/in_crisis_why_are_police_apprehending_more_mentally_ill_people.html).
33 Centre for Addiction and Mental Health. Mental Health and Criminal Justice Policy Framework. 2013.
34 van der Post, LF, Dekker, JJ, Jonkers, JF, Beekman, AT, Mulder, CL, de Haan, L, et al. Crisis intervention and acute psychiatry in Amsterdam, 20 years of change: a historical comparison of consultations in 1983 and 2004–2005. Int J Soc Psychiatry 2010; 56: 348–58.
35 Riecher-Rossler, A, Rossler, W. Compulsory admission of psychiatric patients - an international comparison. Acta Psychiatr Scand 1993; 87: 231–6.
36 Salize, HJ, Dressing, H. Epidemiology of involuntary placement of mentally ill people across the European Union. Br J Psychiatry 2004; 184: 163–8.
37 Mundt, AP, Frančišković, T, Gurovich, I, Heinz, A, Ignatyev, Y, Ismayilov, F, et al. Changes in the provision of institutionalized mental health care in post-communist countries. PLoS ONE 2012; 7: e38490.
38 Bola, JR, Park, EH, Kim, SY. Reassessing the high proportion of involuntary psychiatric hospital admissions in South Korea. Community Ment Health J 2011; 47: 603–6.
39 Zhou, JS, Xiang, YT, Zhu, XM, Liang, W, Li, H, Yi, J, et al. Voluntary and involuntary psychiatric admissions in China. Psychiatr Serv 2015; 66: 1341–6.
40 Steinert, T, Lepping, P, Baranyai, R, Hoffmann, M, Leherr, H. Compulsory admission and treatment in schizophrenia: a study of ethical attitudes in four European countries. Soc Psychiatry Psychiatr Epidemiol 2005; 40: 635–41.
41 Wang, JP, Chiu, CC, Yang, TH, Liu, TH, Wu, CY, Chou, P. The low proportion and associated factors of involuntary admission in the psychiatric emergency service in Taiwan. PLoS ONE 2015; 10: e0129204.
42 Gandy, HM. Form 1 - A powerful and complex tool for managing mental health problems. Paediatr Child Health 2004; 9: 222–4.
43 Hustoft, K, Larsen, TK, Auestad, B, Joa, I, Johannessen, JO, Ruud, T. Predictors of involuntary hospitalizations to acute psychiatry. Int J Law Psychiatry 2013; 36: 136–43.
44 Preti, A, Rucci, P, Santone, G, Picardi, A, Miglio, R, Bracco, R, et al. Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy. Psychol Med 2009; 39: 485–96.
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

BJPsych Open
  • ISSN: -
  • EISSN: 2056-4724
  • URL: /core/journals/bjpsych-open
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×
Type Description Title
UNKNOWN
Supplementary materials

Lebenbaum et al. supplementary material 1
Supplementary Table

 Unknown (28 KB)
28 KB
WORD
Supplementary materials

Lebenbaum et al. supplementary material 2
Supplementary Table

 Word (23 KB)
23 KB

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 317
Total number of PDF views: 294 *
Loading metrics...

Abstract views

Total abstract views: 395 *
Loading metrics...

* Views captured on Cambridge Core between 22nd February 2018 - 19th August 2018. This data will be updated every 24 hours.

Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study

  • Michael Lebenbaum (a1), Maria Chiu (a2), Simone Vigod (a3) and Paul Kurdyak (a4)
Submit a response

eLetters

No eLetters have been published for this article.

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *