Skip to main content Accessibility help
×
Home

Patients' views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries

  • Stefan Priebe (a1), Christina Katsakou (a1), Matthias Glöckner (a2), Algirdas Dembinskas (a3), Andrea Fiorillo (a4), Anastasia Karastergiou (a5), Andrzej Kiejna (a6), Lars Kjellin (a7), Pìtr Nawka (a8), George Onchev (a9), Jiri Raboch (a10), Matthias Schuetzwohl (a2), Zahava Solomon (a11), Francisco Torres-González (a12), Duolao Wang (a13) and Thomas Kallert (a14)...

Abstract

Background

Legislation and practice of involuntary hospital admission vary substantially among European countries, but differences in outcomes have not been studied.

Aims

To explore patients' views following involuntary hospitalisation in different European countries.

Method

In a prospective study in 11 countries, 2326 consecutive involuntary patients admitted to psychiatric hospital departments were interviewed within 1 week of admission; 1809 were followed up 1 month and 1613 3 months later. Patients' views as to whether the admission was right were the outcome criterion.

Results

In the different countries, between 39 and 71% felt the admission was right after 1 month, and between 46 and 86% after 3 months. Females, those living alone and those with a diagnosis of schizophrenia had more negative views. Adjusting for confounding factors, differences between countries were significant.

Conclusions

International differences in legislation and practice may be relevant to outcomes and inform improvements in policies, particularly in countries with poorer outcomes.

  • 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.

      Patients' views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries
      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.

      Patients' views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries
      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.

      Patients' views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries
      Available formats
      ×

Copyright

Corresponding author

Stefan Priebe, Academic Unit, Newham Centre for Mental Health, London E13 8SP, UK. Email: s.priebe@qmul.ac.uk

Footnotes

Hide All

This study was funded by a grant from the European Commission (Quality of life and Management of Living Resources Programme, contract number QLG4-CT-2002-01036).

Declaration of interest

None.

Footnotes

References

Hide All
1 Zinkler, M, Priebe, S. Detention of the mentally ill in Europe – a review. Acta Psychiatr Scand 2002; 106: 38.
2 Salize, HJ, Dressing, H. Epidemiology of involuntary placement of mentally ill people across the European Union. Br J Psychiatry 2004; 184: 163–8.
3 Welsh, S, Deahl, MP. Modern psychiatric ethics. Lancet 2002; 359: 253–5.
4 Zigmond, T. A new Mental Health Act for England and Wales. Adv Psychiatr Treat 2004; 10: 161–3.
5 Tilley, S, Chambers, M. Proposed changes to the Mental Health Act of England and Wales – research investigating the debate. J Psychiatr Ment Health Nurs 2005; 12: 121–3.
6 Katsakou, C, Priebe, S. Outcomes of involuntary hospital admission – a review. Acta Psychiatr Scand 2006; 114: 232–41.
7 Kallert, TW, Glöckner, M, Schutzwohl, M. Involuntary vs. voluntary hospital admission: a systematic literature review on outcome diversity. Eur Arch Psychiatry Clin Neurosci 2008; 258: 195209.
8 Felthouse, A, Sass, H. The International Handbook of Psychopathic Disorders and the Law Vol II: Law and Policies. John Wiley & Sons, 2008.
9 Kallert, TW, Torres-Gonzalez, F. Legislation on Coercive Mental Health Care in Europe. Peter Lang Publications, 2006.
10 Kallert, TW, Rymaszewska, J, Torres-Gonzalez, F. Differences of legal regulations concerning involuntary psychiatric hospitalisation in twelve European countries: implications for clinical practice. Int J Forensic Ment Health 2007; 6: 197207.
11 Beck, JC, Golowka, EA. A study of enforced treatment in relation to Stone's ‘thank you' theory. Behav Sci Law 1988; 6: 559–66.
12 Spence, ND, Goldney, RD, Costain, WF. Attitudes towards psychiatric hospitalization: a comparison of involuntary and voluntary patients. Aust Clin Rev 1988; 8: 108–16.
13 Towes, J. Change with time in patients' reactions to committal. Can J Psychiatry 1986; 31: 413–5.
14 Kjellin, L, Westrin, CG, Eriksson, K, Alexsson-Ostman, M. Coercion in psychiatric care: problems of medical ethics in a comprehensive empirical study. Behav Sci Law 1993; 11: 323–34.
15 Kjellin, L, Anderson, K, Bartholdson, E, Candefjord, IL, Holmstrom, H, Jacobsson, , et al. Coercion in psychiatric care – patients' and relatives' experiences from four Swedish psychiatric services. Nord J Psychiatry 2004; 58: 153–9.
16 Kane, JM, Quitkin, F, Rifkin, A, Wegner, J, Rosenberg, G, Borenstein, M. Attitudinal changes of involuntarily committed patients following treatment. Arch Gen Psychiatry 1983; 40: 374–7.
17 Srinivasan, DP, Soundarajan, PC, Hullin, RP. Attitudes of patients and relatives to compulsory admission. Br J Psychiatry 1980; 136: 200–1.
18 Rusius, C. The Mental Health Act 1983 – what does the patient think? Psychiatr Bull 1992; 16: 268–9.
19 Kallert, TW, Glöckner, M, Onchev, G, Raboch, J, Karastergiou, A, Solomon, , et al. The EUNOMIA project on coercion in psychiatry: study design and preliminary data. World Psychiatry 2005; 4: 168–72.
20 World Health Organization. The ICD–10 Classification of Mental and Behavioural Disorders: Diagnostic Criteria for Research (DCR–10). WHO, 1998.
21 Ventura, J, Green, MF, Shaner, A, Liberman, R. Training and quality assurance with the Brief Psychiatric Rating Scale: ‘The Drift Busters’. Int J Methods Psychiatric Res 1993; 3: 221–4.
22 Liang, KY, Zeger, SL. Longitudinal data analysis using generalized linear models. Biometrika 1986; 73: 1322.
23 Kjellin, L, Anderson, K, Candefjord, I, Palmstierna, T, Wallsten, T. Ethical benefits and costs of coercion in short-term inpatient psychiatric care. Psychiatr Serv 1997; 48: 1567–70.
24 Priebe, S, Katsakou, C, Amos, T, Leese, M, Morriss, R, Rose, D, et al. Patients' views and readmissions 1 year after involuntary hospitalisation. Br J Psychiatry 2009; 194: 4954.
25 European Commission. Improving the Mental Health of the Population. Towards a Strategy on Mental Health for the European Union. European Commission, 2005.
26 Lehman, AF. The effects of psychiatric symptoms on quality of life assessments among the chronically mentally ill. Eval Program Plann 1983; 6: 143–51.
27 Vandiver, VL. Quality of life, gender and schizophrenia: a cross-national survey in Canada, Cuba and the USA. Community Ment Health J 1998; 34: 501–52.
28 Dinos, S, Stevens, S, Serfaty, M, Weich, S, King, M. Stigma: the feelings and experiences of 46 people with mental illness. Qualitative study. Br J Psychiatry 2004; 184: 176–81.
29 Priebe, S, Frottier, P, Gaddini, A, Kilian, R, Lauber, C, Martínez-Leal, R, et al. Mental health care institutions in nine European countries, 2002 to 2006. Psychiatr Serv 2008; 59: 570–3.
30 Katsakou, C, Priebe, S. Patients' experiences of involuntary hospital admission and treatment: a review of qualitative studies. Epidemiol Psichiatr Soc 2007; 16: 172–8.

Patients' views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries

  • Stefan Priebe (a1), Christina Katsakou (a1), Matthias Glöckner (a2), Algirdas Dembinskas (a3), Andrea Fiorillo (a4), Anastasia Karastergiou (a5), Andrzej Kiejna (a6), Lars Kjellin (a7), Pìtr Nawka (a8), George Onchev (a9), Jiri Raboch (a10), Matthias Schuetzwohl (a2), Zahava Solomon (a11), Francisco Torres-González (a12), Duolao Wang (a13) and Thomas Kallert (a14)...

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed

Patients' views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries

  • Stefan Priebe (a1), Christina Katsakou (a1), Matthias Glöckner (a2), Algirdas Dembinskas (a3), Andrea Fiorillo (a4), Anastasia Karastergiou (a5), Andrzej Kiejna (a6), Lars Kjellin (a7), Pìtr Nawka (a8), George Onchev (a9), Jiri Raboch (a10), Matthias Schuetzwohl (a2), Zahava Solomon (a11), Francisco Torres-González (a12), Duolao Wang (a13) and Thomas Kallert (a14)...
Submit a response

eLetters

Legislation, Psychiatry Practice and Patient views

PARTHA PRATIM DAS, Registrar
02 June 2010

Priebe et al (1) highlights the important issue of legislation and patient views across different European countries. The authors should be congratulated at the outset for conducting the study in a field which is scarcely researched and fraught with ethical and political issues. The study boasts a number of strengths in the form of a good sample size, clear inclusion and exclusion criteria, consecutive sampling, fixed interval of assessments, use of independent researchers, and attempts to control confounding. The hypothesis generated about differences between countries is an intuitive attempt to tease out protective factors implicated in more positive responses. It even perhaps help to compare legislation and predict views in countries not included in the sample. However, their finding of differences in legislation influencing the views of patients asthe most important factor needs to be examined more closely. Contrary to the authors’ assumption at the beginning of the paper (1) about countries across Europe sharing a similar historical and social background, there isevidence to suggest the practice of Psychiatry actually differs (2). Moreover, involuntary admission rates are reducing in countries like Spain, Sweden, and Italy but increasing in England, Germany – can this influence the patient outcomes? (3) The results in Table 2 are a pointer if one compares hospitalization rates at the end of 1 month. Countries like Bulgaria, Germany, Lithuania, and Poland had more than 70% of the sample remaining in hospital compared to Italy (5%), Spain (9%) and Sweden(37%). If such is the case then it begs the question whether data from different countries can be compared. Further, details about outpatient commitment and provision of assertive community treatment which may enabletreatment in a less restrictive manner could have enhanced understanding of patient views. The study excludes countries like Finland which had reported one of the highest involuntary admission rates, (4) and France. The study could have been enhanced by the collection of other important information which is likely to influence patient views like duration of involuntary period, any episodes of seclusion or restraint use, number of involuntary admissions rather than hospitalization, ethnicity, patient’s family situation, and gender of admitting psychiatrist. Other methodological issues which raise questions about the study findings relate to the observation that a significant proportion of the patient group had dropped out. The patient response to the asked question indicates response bias, as is often common with Likert type scales. The majority chose either the middle value (12% chose 5 rating at 1 month) or extremes (22% chose 10 rating at 1 month, 24% chose 10 rating at 3 months). Finally, in the GEE model the P value of 0.05 was chosen which increases the probability of finding an association by chance to one in twenty alone.

The study aimed to assess patient’s subjective views of involuntary admission; this inquiry, could have been strengthened by using a qualitative methodology. Further research might also usefully study voluntary patient’s subjective views about coercion.

Corresponding Author: Dr. Partha Pratim Das, MBBS MD Senior Registrar, Northwestern Area Mental Health Service, 130 Bell St, Coburg, Vic 3058, Australia. Email: drparthapratimdas@yahoo.com

... More

Conflict of interest: None References 1.Priebe S, Katsakou C, Glockner 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. The British Journal of Psychiatry 2010; 196: 179–185 2.Furedi J, Mohr P, Swingler D, Bitter I, Gheorghe MD, Hotujac L, et al. Psychiatry in selected countries of Central and Eastern Europe: an overview of the current situation. Acta Psychiatr Scand 2006: 114: 223–231 3.Høyer G. Involuntary hospitalization in contemporary mental health care. Some (still) unanswered questions Journal of Mental Health 2008; 17(3): 281–292 4.Alessia de Stefano, Giuseppe Ducci. Involuntary Admission and Compulsory Treatment in Europe: An Overview. International Journal of Mental Health 2008;37:10-21

Write a reply

×

Reply to: Submit a response


Your details


Conflicting interests

Do you have any conflicting interests? *