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1.
Eur Child Adolesc Psychiatry ; 33(1): 303-313, 2024 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-36792866

RESUMO

Emergency inpatient admissions of children and adolescents are more difficult if the patient is admitted involuntarily and/or the caregivers or custodians of institutional care are absent. The present study aimed to clinically characterize involuntary versus voluntary admissions by examining the reasons for presentation and associated factors. We retrospectively analyzed patients who presented to the emergency department of a hospital for child and adolescent psychiatry in Bavaria, Germany, and were admitted as inpatients for crisis intervention in the 4th quarter of 2014-2018. Reasons for presentation, clinical and sociodemographic characteristics, and type of admission (voluntary versus involuntary) were analyzed for 431 emergency inpatient admissions. A total of 106 (24.6%) patients were involuntarily admitted. In a binominal logistic regression, presentation due to alcohol consumption, deviant social behavior, and psychosocial burden was positively associated, whereas difficulties at school and depression were negatively associated, with the likelihood of involuntary admission. 58.5% of the 123 unaccompanied patients were admitted involuntarily. Reasons for the presentation of unaccompanied and voluntary inpatient admissions were suicidal thoughts, psychosocial burden, and externalized aggression. A substantial number of child and adolescent psychiatric admissions represent emergency admissions. Involuntarily admitted patients and unaccompanied children/adolescents represent a non-negligible proportion of clinical routine and the clinical and legal background factors need to be further clarified in future studies. This study is registered in the German Clinical Trials Register (24 September 2019, DRKS00017689).


Assuntos
Transtornos Mentais , Admissão do Paciente , Adolescente , Criança , Humanos , Pacientes Internados , Psiquiatria do Adolescente , Estudos Retrospectivos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Internação Compulsória de Doente Mental , Hospitais Psiquiátricos , Alemanha/epidemiologia
3.
Psychiatr Prax ; 51(1): 24-30, 2024 Jan.
Artigo em Alemão | MEDLINE | ID: mdl-37683673

RESUMO

OBJECTIVE: To examine sociodemographic and clinical characteristics of persons hospitalized in five psychiatric hospitals from regions with different structural characteristics compared with persons hospitalized voluntarily. METHODS: Descriptive analyses of routine data on approximately 57000 cases of 33000 patients treated for a primary ICD-10 psychiatric diagnosis at one of the participating hospitals from 2016 to 2019. RESULTS: Admission rates, length of stay, rates of further coercive measures, sociodemographic and clinical characteristics of the affected persons differ between the different regions. CONCLUSION: There are considerable regional differences between regulations and implementation of the admission procedures and the sample. Causal relationships between regional specifics and the results cannot be inferred.


Assuntos
Transtornos Mentais , Humanos , Suíça , Alemanha , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Fatores de Risco , Hospitais Psiquiátricos , Internação Compulsória de Doente Mental
5.
Int J Law Psychiatry ; 91: 101938, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37956559

RESUMO

BACKGROUND: Involuntary admission is widely used in psychiatry, usually requiring that the patient present an imminent danger to himself or others. Previous studies have established several predictors for involuntary admission, but they have been almost exclusively conducted in Western European or North American countries. By contrast, data on this topic from Eastern European countries is virtually absent. Historically, involuntary admission has been often used as a tool for political repression in Romania before the fall of the communist regime. While there have been significant changes in the legal framework in the last 30 years, there is still no real-world data to build upon. METHODS: We analyzed a sample of 177 patients admitted to the "Alexandru Obregia" psychiatric hospital in Bucharest between November 2022 and January 2023, of which 49.7% (88) were involuntary hospitalizations. We collected socio-demographic and clinical data by both by direct interview, and by consulting patient records, attending physicians and relatives. RESULTS: Socio-demographic factors predictive for involuntary admission were unemployment, lower income, and urban living. Of the clinical variables analyzed, diagnosis of psychosis or mania on admission carried increased risk of involuntary hospitalization, as did nonadherence to treatment, higher disease severity and aggression. Hospital presentation by police or ambulance carried significant additional risk compared to self-referral. CONCLUSION: Certain categories of patients are considerably more likely to be involuntarily hospitalized and there appears to be considerable interrelatedness between the identified risk factors.


Assuntos
Transtornos Mentais , Transtornos Psicóticos , Humanos , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos Mentais/diagnóstico , Romênia , Internação Compulsória de Doente Mental , Agressão/psicologia , Fatores de Risco , Hospitalização , Admissão do Paciente
7.
Int J Law Psychiatry ; 91: 101934, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37738688

RESUMO

BACKGROUND: Involuntary admissions (IA) to psychiatric hospitals are controversial because they interfere with people's autonomy. In some situations, however, they appear to be unavoidable. Interestingly, not all patients perceive the same degree of coercion during IA. The aim of this study was to assess whether the level of knowledge about one's own IA is associated with perceived coercion. METHODS: This multicenter observational study was conducted on n = 224 involuntarily admitted patients. Interviews were conducted at five study centers from April 2021 to November 2021. The Macarthur Admission Experience Survey was administered to assess perceived coercion. Knowledge of involuntary admission, perceptions of information received, and attitudes towards legal aspects of involuntary admission were also assessed. RESULTS: We found that higher levels of knowledge about IA were negatively associated with perceived coercion at admission. Perceived coercion did not differ between study sites. Only half of the patients felt well informed about their IA, and about a quarter found the information they received difficult to understand. DISCUSSION: Legislation in Switzerland requires that patients with IA be informed about the procedure. Strategies to improve patients' understanding of the information given to them about IA might be helpful to reduce perceived coercion, which is known to be associated with negative attitudes towards psychiatry, a disturbed therapeutic relationship, avoidance of psychiatry, and the risk of further coercion.


Assuntos
Transtornos Mentais , Psiquiatria , Humanos , Coerção , Suíça , Hospitalização , Pacientes , Hospitais Psiquiátricos , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Internação Compulsória de Doente Mental
8.
J Am Acad Psychiatry Law ; 51(3): 353-356, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37580107

RESUMO

The procedures and outcomes of conditional release of insanity acquittees is a relatively neglected area of forensic psychiatric research. The release procedures vary in individual states, resulting in a wide range of approaches, from the careful selection of appropriate patients and strict monitoring in the community, to literally no mechanism for ensuring the future safety of such individuals. In North Carolina there are institutional barriers which even hinder research on the outcomes of such cases. Haroon and colleagues report on the post-release outcomes of insanity acquittees in North Carolina from 1996 to 2020. The findings of the researchers are analyzed in light of the lack of a formal post-release monitoring system in their state, contrasted with outcomes in states where a strict monitoring program is in place. Commentary is provided on the study findings, including associations between demographic, psychiatric, and criminological characteristics of insanity acquittees and release outcomes, as well as an apparent systemic bias against minority acquittees in the insanity commitment and release process in North Carolina. Further research on this important topic, from additional state jurisdictions, is recommended.


Assuntos
Defesa por Insanidade , Transtornos Psicóticos , Humanos , Internação Compulsória de Doente Mental , Psiquiatria Legal , Medicina Legal
9.
Emerg Med Australas ; 35(6): 896-902, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37638384

RESUMO

Every day in EDs, clinicians are faced with situations where they need to decide whether to detain a patient for assessment and treatment. For patients who meet the relevant criteria, provisions of mental health legislation can be used. For other patients, clinicians often rely on so-called 'duty of care'. This article briefly explores this complex area of law, including the relevant legislation, common law principles and grey areas. It also proposes an approach to decision-making in this area.


Assuntos
Internação Compulsória de Doente Mental , Saúde Mental , Humanos , Restrição Física , Serviço Hospitalar de Emergência
10.
J Am Acad Psychiatry Law ; 51(3): 411-420, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37550061

RESUMO

COVID-19 strongly affected referral of individuals from Oregon's courts and the ability of Oregon State Hospital (OSH) to accept patients. Despite acceleration in the decline in civil commitment, competency to stand trial (CST) admissions increased, causing a bed crisis at OSH, which in turn affected community hospitals and jails. In 1993, the Ninth Circuit Court of Appeals mandated admission of jail detainees to OSH within seven days after a judicial order for CST evaluation or restoration. During COVID, as the number of such patients increased to crisis proportions, average jail detention times exceeded seven days. An inevitable judicial process intensified in the U.S. District Court of Oregon after OSH requested a COVID-related modification of the seven-day limit. This commentary demonstrates more clearly than in the past that there is a negative correlation between civil commitment and competency restoration as components of an interrelated system. After updating the situation in Oregon, this article ends with suggested interventions to improve Oregon's civil and criminal commitment processes, hoping for better care of patients and improved administration of justice.


Assuntos
COVID-19 , Serviços de Saúde Mental , Humanos , Internação Compulsória de Doente Mental , Oregon
11.
Psychiatry Res ; 327: 115377, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37562153

RESUMO

Community treatment orders (CTOs) have been associated with reduced crime/victimization-risk. Australia's ratification of the U.N. Convention on the Rights of Persons with Disabilities (CRPD) enabled patient-rights-advocacy to limit CTO-assignment to persons lacking decision-making-capacity. This effort was accompanied by a 15% reduction in CTO-utilization. Has this change affected crime/victimization-involvements of patients with schizophrenia-diagnoses? In Victoria Australia, the study considers crime/victimization-involvement among three patient-groups recruited with the same sampling-algorithm in the decade before (2000-2009, N = 14,711) and after (2010-2019, N = 10,702) CRPD-ratification. Each group is its own-control. Each group's positive-outcome across decades would be "no increase" in crime/victimization-involvement or in the ratio of the group's incident-rates to the State's. Following CRPD-ratification, first-hospitalized-patients with at least one CTO-assignment doubled their involvement in major crime-perpetrations (from 13% to 27%), non-CTO-hospitalized-patients almost doubled (from 10% to 18%), and 11% of outpatients were involved when none were before. Overall, a third (34%) were victimized-by-major-crime up from 28%, with 25% of outpatients experiencing victimization when none had before. Increases were most evident in major-crimes, led by assaults/abductions. Capacity-constraints on compulsory-treatment are associated with increases in crime/victimization-involvement, a transfer of responsibility for patients with schizophrenia-diagnoses from the mental-health-system to the criminal-justice-system, validation of dangerousness stereotypes, and growing negative family impact.


Assuntos
Vítimas de Crime , Transtornos Mentais , Esquizofrenia , Humanos , Transtornos Mentais/terapia , Internação Compulsória de Doente Mental , Crime , Esquizofrenia/terapia , Direitos Civis , Vitória
12.
J Am Acad Psychiatry Law ; 51(3): 342-352, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37399257

RESUMO

Over the past two decades, an increasing proportion of North Carolina state psychiatric hospital beds have been used to house forensic patients. Insanity acquittees occupy almost all forensic-designated beds in the state. Despite the effect insanity acquittees have on state hospital use in North Carolina, outcomes for acquittees after they are released from the state hospital are unknown because of a lack of previous research. This study evaluates postrelease outcomes for insanity acquittees discharged from the North Carolina Forensic Treatment Program between 1996 and 2020. The study also describes the association between the demographic, psychiatric, and criminological characteristics of insanity acquittees and outcomes of recidivism or rehospitalization. The results show that insanity acquittees in North Carolina have higher rates of criminal recidivism than acquittees in other states. There is also evidence of systemic bias against minority race acquittees in the insanity commitment and release process in North Carolina. Outcomes for insanity acquittees released from the state Forensic Treatment Program could be improved through the introduction of evidence-based practices widely used in other states.


Assuntos
Defesa por Insanidade , Transtornos Psicóticos , Humanos , North Carolina , Internação Compulsória de Doente Mental , Readmissão do Paciente , Psiquiatria Legal
13.
J Am Acad Psychiatry Law ; 51(3): 357-366, 2023 09.
Artigo em Inglês | MEDLINE | ID: mdl-37277160

RESUMO

Involuntary civil commitment for individuals who are chronically impaired as a result of their substance use remains highly controversial. At present, 37 states have legalized this practice. Increasingly, states are allowing private third-parties, such as friends or relatives of the patient, to petition courts for involuntary treatment. One such approach, modeled on Florida's Marchman Act, does not determine status based on the petitioning party's willingness to commit to pay for care. In contrast, Kentucky's approach, widely known as "Casey's Law," predicates such involuntary commitment on the third party's willingness to commit in advance to pay for the patient's treatment. This article reviews the history and current status of existing law on this subject and then argues that psychiatrists should advocate strongly against involuntary substance treatment laws that rely upon third-party pledges of payment.


Assuntos
Internação Involuntária , Tratamento Involuntário , Transtornos Relacionados ao Uso de Substâncias , Humanos , Internação Compulsória de Doente Mental , Declarações Financeiras , Transtornos Relacionados ao Uso de Substâncias/terapia
14.
Swiss Med Wkly ; 153: 40063, 2023 04 27.
Artigo em Inglês | MEDLINE | ID: mdl-37190905

RESUMO

AIMS: The main objective of this study was to describe patients who were involuntarily admitted to the emergency department of Lausanne University Hospital on involuntary admission in 2018 in terms of age, gender, emergency department length of stay, the motive for involuntary admission, use of psychoactive substances, diagnosis, and destination at emergency department discharge, with or without discontinuation of involuntary admission. METHODS: This retrospective, observational, and monocentric study included patients 18 years and older admitted to the emergency department of Lausanne University Hospital on involuntary admission from January 1, 2018, to December 31, 2018. Patients were identified by the Cantonal Medical Office of Vaud. The emergency department length of stay and patient destination on discharge from the emergency department were extracted from the patient flow database, and discharge letters and involuntary admission were extracted from the electronic archiving software. Descriptive statistics were processed by using means and standard deviations for quantitative variables with a normal distribution and median and interquartile range for non-normally distributed data. RESULTS: During the study period, 83 patients were admitted on involuntary admission to the emergency department. The majority of the patients were male (58%) with a mean age of 55 (±20) years. The median emergency department length of stay of patients with an involuntary admission was between 9 and 16 hours, depending on whether the involuntary admission was confirmed or discontinued after patient assessment in the emergency department. In comparison, the median emergency department length of stay was 6 hours for patients overall. The two principal diagnoses described were psychiatric (schizophrenia) and mental and behavioural disorders due to psychoactive substance use. Half of the patients on involuntary admission consumed psychoactive substances, primarily alcohol, and had a mean ethanolaemia of 53 (±32) mmol/l. CONCLUSIONS: Only a third of patients admitted on involuntary admission saw this measure confirmed after their assessment in the emergency department. Involuntary admissions with admission to the emergency department is used to force patients to be examined by an emergency physician or even a psychiatrist. On-call and primary care physicians seemed to lack the time or resources to set up alternatives to emergency department admissions on involuntary admission, especially in situations in which the involuntary admission was discontinued after an emergency department assessment. This demonstrates the inappropriate use of this measure because a patient cannot be involuntarily hospitalised in an emergency department.


Assuntos
Transtornos Mentais , Esquizofrenia , Transtornos Relacionados ao Uso de Substâncias , Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Internação Compulsória de Doente Mental , Estudos Retrospectivos , Transtornos Mentais/diagnóstico , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Serviço Hospitalar de Emergência , Admissão do Paciente
16.
Int Rev Psychiatry ; 35(2): 163-166, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37105151

RESUMO

Since 1989, the major professional organization of psychiatrists has expressed concern for the human rights of people with mental disorders: "Involuntary intervention is a great infringement of the human rights and the fundamental freedom of a patient. Therefore, specific, and carefully defined criteria and safeguards are needed for such intervention. Hospitalization or treatment against the will of a patient should not be conducted unless the patient suffers from serious mental illness. Involuntary intervention must be conducted in accordance with the least restrictive principle.


Assuntos
Pessoas com Deficiência , Transtornos Mentais , Humanos , Internação Compulsória de Doente Mental , Nações Unidas , Direitos Humanos , Transtornos Mentais/terapia , Hospitalização
17.
Schizophr Res ; 255: 189-194, 2023 05.
Artigo em Inglês | MEDLINE | ID: mdl-37003238

RESUMO

OBJECTIVE: Adversarial hearings in hospital commitment and de novo treatment proceedings, or court hearings, delay psychiatric treatment in many jurisdictions. In Massachusetts, the "treatment over objection" process requires a court petition. For state hospital patients, the delay to treatment is an initial 34 day waiting period in addition to continuances of court hearings that extend treatment delays. This study examined the frequency of adverse medical events due to delayed court hearings within a forensic state hospital in the US. METHODS: The study reviewed all (n = 355) treatment petitions filed by a Massachusetts forensic hospital from 2015 and 2016. The incidence and nature of adverse events (e.g. patient/staff assaults, milieu disruptions) and acute medical symptoms (e.g. catatonia, acute psychosis), before and after the Court granted a petition for treatment, were analyzed by two raters. Adverse events included patient and staff assaults, acute psychiatric symptoms, and milieu problems. RESULTS: 82.6 % of treatment petitions led to involuntary treatment, 16.6 % were withdrawn by the medical petition filer, and only 0.8 % petitions were denied by the judge. Adversarial hearings occasioned an average delay of 41 days from treatment petition filing to receipt of standing treatment in addition to statute required delays. Once treatment was court-approved, all types of adverse events were significantly reduced. CONCLUSIONS: Results established that the court treatment hearing scheme exacerbates health and safety risks to patients with serious mental illness. Increasing physician and court personnel awareness of these risks is likely key to enhancing a patient-focused, rights-oriented approach to these matters. This and other recommendations is proposed for jurisdictions that deal with this problem around the world.


Assuntos
Internação Compulsória de Doente Mental , Transtornos Psicóticos , Humanos , Hospitais Psiquiátricos
20.
Soc Psychiatry Psychiatr Epidemiol ; 58(9): 1343-1352, 2023 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-36997745

RESUMO

PURPOSE: The Mental Health Act in Scotland is under review. Previous iterations increased patients' rights but the maximum time for short-term detentions remains unchanged, despite evolving psychiatric treatment models. We explored length, mode of ending and factors of influence on the application of short-term detention certificates (STDCs), which can last up to 28 days, across Scotland between 2006 and 2018. METHODS: Data on age, gender, ethnicity, date of commencement and ending of the STDC and detention site from all 42,493 STDCs issued to 30,464 patients over 12 years were extracted from the national repository for detentions under the Mental Health (Care and Treatment) (Scotland) Act 2003 and analysed using mixed models. RESULTS: One in five STDCs lapsed on day 28. Two in five were revoked and the remainder extended to a treatment order. STDCs that were not extended averaged 19 days, and revoked STDCs 14 days. The probability of a detention lapsing varied across hospitals and increased with patient age. The odds of a detention lapsing on day 28 were 62% lower and revoked detentions 10% shorter in 2018 relative to 2006. The odds of a detention extending decreased significantly from 2012 to 2018. Extended STDCs were associated with increased patient age, male gender, and ethnicity other than White Scottish. There was little initiation of or active revocation of STDCs on weekend days. CONCLUSION: The length of STDCs reduced over time, fewer detentions lapsed, and weekday patterning was evident in each year. These data can inform legislative and service reviews.


Assuntos
Internação Compulsória de Doente Mental , Transtornos Mentais , Saúde Mental , Humanos , Etnicidade , Transtornos Mentais/epidemiologia , Transtornos Mentais/terapia , Escócia/epidemiologia
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