Perfil epidemiológico de los ingresos involuntarios en el Servicio de Psiquiatría del Hospital Universitario de Gran Canaria Doctor Negrín / Epidemiological profile of involuntary admission in the Psychiatry Service of The University Hospital of Gran Canaria Doctor Negrin

Introducción los ingresos involuntarios por razón de trastorno psíquico se producen con relativa asiduidad en las unidades de internamiento hospitalarias de nuestro país. Este trabajo someterá a estudio las características socio-demográficas y clínicas que se encuentran en relación con este tipo de pacientes, para disponer de más información, tanto clínica como legal, con la que trabajar y desempeñar una mejor función, administración de recursos y desarrollo de habilidades necesarias ante estas situaciones. Material y métodos estudio observacional descriptivo retrospectivo, en el cual se analizarán diferentes variables, seleccionadas previamente, presentes en la población de pacientes psiquiátricos ingresados involuntariamente en el Hospital Doctor Negrín en un período de tiempo de 2 años, 2019 y 2020, determinando así el grado de prevalencia de cada una de ellas. Resultados entre las variables más asociadas al ingreso involuntario se encuentran: ser varón, en la cuarta década de la vida, soltero, sin hijos ni empleo y con un diagnóstico de trastorno psicótico o afectivo mayor que muy probablemente ha abandonado el tratamiento. Discusión sería conveniente hacer un especial seguimiento a los pacientes que cumplan el perfil anteriormente descrito con el objetivo de minimizar la involuntariedad. Es necesario el desarrollo de programas educacionales, de seguimiento y adherencia al alcance de la población de pacientes psiquiátricos para así poder minimizar la necesidad de ingresos involuntarios en nuestro medio. (AU)

Introduction Involuntary admissions due to mental disorders occur with relative regularity in hospital admission units in our country. This work will study the socio-demographic and clinical characteristics found in relation to this type of patients, in order to have more information, both clinical and legal, with which to work and perform a better function, administration of resources and development of necessary skills in these situations. Material and methods Retrospective descriptive observational study, in which different variables will be analyzed, previously selected, present in the population of psychiatric patients involuntarily admitted to the Doctor Negrín Hospital in a period of 2 years, 2019 and 2020, thus determining, the degree of prevalence of each of them. Results Among the variables most associated with involuntary admission are, being a man, in the fourth decade of life, single, without children, or employment, with a diagnosis of major psychotic or affective disorder who has most likely abandoned treatment. Discussion It would be advisable to carry out a special follow-up of patients who meet the profile described above in order to minimize involuntary occurrence. It is necessary to develop educational, follow-up and adherence programs within the reach of the population of psychiatric patients in order to minimize the need for involuntary admissions in our environment. (AU)

People brought to the emergency department under involuntary assessment orders: A scoping review.

BACKGROUND: Some people with mental health problems arrive to the Emergency Department (ED) under involuntary assessment orders (IAOs) and can have complex medical and socioeconomic factors, which may impact on the delivery of care in the ED. Therefore, this scoping review aimed to identify, evaluate and summarise the current literature regarding the demographic characteristics, clinical characteristics and outcomes for people brought to the ED under IAOs. METHOD: A scoping review was undertaken guided by the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Guidelines and the Arksey and O'Malley framework. RESULTS: In total 21 articles were included in this review. People under IAOs most commonly present to EDs with suicidal ideation/intent, with interagency involvement noted when responding to these people in the pre-hospital setting. Most people arriving to ED under IAOs were reported to experience length of staylonger than four hours. CONCLUSION: This review highlights the limited information pertaining to people brought to EDs under an IAO. High levels of mental health problems and extended length of stay for people under IAOs suggests the need for interagency collaboration to inform the development and implementation of models of care that incorporates social determinants of health and are tailored to this complex population.

Ingresos psiquiátricos en un gran hospital de Madrid durante el confinamiento por COVID-19: ¿existió un cambio en el perfil de pacientes? / Psychiatric admissions in a large hospital in Madrid during covid-19 lockdown: was there a change in patient profile?

Introducción. El COVID-19 supuso en Madrid la reorganización de la asistencia sanitaria. El objetivo de este estudio es describir el perfil sociodemográfico y clínico en los pacientes psiquiátricos que ingresaron en el Hospital Gregorio Marañón durante el confinamiento. Material y métodos. Se realizó un estudio trasversal retrospectivo en el que se recogieron datos de todos los ingresos en nuestra unidad de hospitalización psiquiatría del 15 de marzo al30 de mayo de los años 2019 y 2020. Se elaboró un protocolo que incluía variables clínicas y sociodemográficas, junto a una serie de variables referidas al año previo al ingreso. Además de estadísticos descriptivos, utilizamos la t de Student para comparar variables cuantitativas y χ² para las cualitativas. Resultados. En 2020 la población atendida aumento un312,5%, mientras los ingresos subieron únicamente un 2,5%.El nivel socioeconómico fue significativamente más bajo en 2020 (χ²=18,041; p=0,001). El número de hospitalizaciones previas era significativamente mayor en los pacientes de 2019 (t=2.147; p=0.032), pero las variables que medían únicamente el año previo registraban más tiempo de psicopatología (χ²=7,407; p=0,025) y de hospitalización(χ²=16,765; p=0,000) en 2020, así como relaciones familiares más disfuncionales (χ²=33,819; p=0,000) y menor autonomía(χ²=6,387; p=0,041). La duración del ingreso índice fue significativamente menor en 2020 (t=2.977; p=0.003). Existían también diferencias significativas en el motivo del ingreso, el diagnóstico y el consumo de sustancias. Conclusiones. Observamos una disminución de la asistencia a los servicios de urgencia y de la necesidad de ingreso hospitalario y un aumento en la proporción de ingresos en personas con contexto socio-familiar desfavorable y con trastornos psicóticos y bipolares. (AU)

Introduction. COVID-19 led to a reorganization of healthcare in Madrid. The objective of this study is to describe thesociodemographic and clinical profile of psychiatric patients admitted to Gregorio Marañón Hospital during lockdown. Methods. A retrospective cross-sectional study was conducted and data were collected from all admissions to ourpsychiatric unit from March 15 to May 30, 2019 and 2020. Aprotocol was developed including clinical and sociodemographic variables and a series of variables referring to theyear prior to admission. In addition to descriptive statistics,we used Student’s t test to compare quantitative variables and χ² for qualitative variables. Results. In 2020, the attended population increased by312.5%, while admissions increased only 2.5%.Socioeconomic status was significantly lower in 2020 (χ²=18.041; p=0.001). The number of previous hospitalizations was significantly higher in 2019patients (t=2,147; p=0.032), but the variables that measured only the previous year reflected more time of psychopathology (χ²=7.407; p=0.025) and hospitalization (χ²=16,765; p = 0.000) in 2020, as well as more dysfunctional family relationships (χ²=33.819; p=0.000) and less autonomy (χ²=6.387; p=0.041). The index admission was significantly shorter in 2020 (t=2.977; p=0.003). There were also significant differences in the reason for admission, diagnosis, and substance use. Conclusions. There was a decrease in attendance to emergency services and the need for hospital admissions and an increase in the proportion of admissions in people with an unfavorable social and family background and with psychotic and bipolar disorders.

Internamiento involuntario vs. Retención ilegal en pacientes contrastorno mental grave / Involuntary internment vs. Illegal retention in patients with serious mental disorder

Aunque una buena actitud hacia la terapia y el cumplimiento de la misma son claves para el éxito del tratamiento, en ciertas situaciones el uso de medidas coercitivas en personas con trastornos mentales es la única forma de prevenir daños graves al paciente y a otras personas. La decisión de utilizar estas medidas, como el internamiento involuntario, es un desafío para los médicos, ya que tienen que lidiar no solo con la voluntad del paciente y de sus familiares, que se encuentran en una situación emocional desbordada, sino también con el conocimiento de la normativa vigente, especialmente complejas. Para proteger los derechos del paciente en estas situaciones difíciles y del personal clínico, es esencial que el mismo conozca los límites de su actuación en el marco del procedimiento legal. Por ello, se necesitan más estudios en la materia, que ofrezcan conclusiones contrastadas con respecto a las diferencias entre el internamiento involuntario y la retención ilegal.(AU)

Even though a good attitude towards therapy and adherence are key to an effective treatment, in certain circumstances the use of coercive actions in people with mental disorders is the only way to prevent serious harm to the patient and to others. The choice to use coercive measures, such as involuntary internment, is a challenge for doctors, since not only do they have to deal with the patient and their relatives who are in a highly emotional situation, but there are also complex legal regulations. To defend the rights of patients in these difficult situations, and to avoid legal consequences for clinical staff due to illegal acts, it is essential that staff are familiar with all of the relevant legal rules and procedures. Further studies are warranted to obtain clear conclusions regarding differences between involuntary internment and illegal retention.(AU)

Clasificando mujeres: diagnósticos psiquiátricos y subjetividad femenina en el Manicomio Provincial de Málaga, España, 1909-1950 / Classifying the women: psychiatric diagnoses and female subjectivity in the Manicomio Provincial de Málaga, Spain, 1909-1950

Resumen Las historias clínicas de manicomios de mujeres permiten ahondar en la brecha que se abre entre la ilusión positivista de la psiquiatría durante la primera mitad del siglo XX en España y la vivencia subjetiva del internamiento psiquiátrico de las mujeres-locas doblemente subalternas. Las clasificaciones diagnósticas fueron claves en este intento de positivización. El objetivo de este trabajo es señalar qué elementos subjetivantes participaron en la aplicación de diagnósticos como esquizofrenia, psicopatía y oligofrenia en la sala de mujeres del Manicomio Provincial de Málaga, y mostrar cómo el ideal hegemónico de feminidad estableció un límite permeable entre la cordura y la locura de las mujeres, entre asimilaciones y resistencias.

Abstract The clinical histories of women's asylums allow us to deepen the gap between the positivist illusion of psychiatry during the first half of the 20th century in Spain and the subjective experience of the psychiatric internment of doubly subaltern crazy women. Diagnostic classifications were key in this attempt at positivization. This paper aims to point out which subjectifying elements participated in the application of diagnoses such as schizophrenia, psychopathy, and oligophrenia in the women's wards of the Manicomio Provincial de Málaga, and to show how the hegemonic ideal of femininity established a permeable limit between sanity and madness of women, between assimilations and resistances.

O direito à internação psiquiátrica no sistema de saúde brasileiro: as representações sociais do Tribunal de Justiça de São Paulo / The right to psychiatric admission in the Brazilian health system: the São Paulo Court of Justice' social representations

Este artigo teve como objetivo analisar as representações sociais do Tribunal de Justiça de São Paulo sobre o direito à internação psiquiátrica no sistema de saúde brasileiro. Os dados foram coletados do sítio eletrônico do tribunal paulista, a partir de 184 acórdãos de ações julgadas em segunda instância, proferidos em razão de recursos de apelação e publicados no período de janeiro de 1998 a dezembro de 2012, referentes às internações psiquiátricas pleiteadas no Sistema Único de Saúde e no sistema de saúde suplementar. Os métodos empregados para análise dos resultados foram a estatística descritiva e o discurso do sujeito coletivo. Aplicou-se, ainda, a Teoria das Representações Sociais como referencial teórico de interpretação dos discursos elaborados. No Sistema Único de Saúde, a internação reclamada em juízo foi a compulsória, representada, majoritariamente, como medida de proteção da dignidade da pessoa com transtorno mental e, minoritariamente, como violência contra essa mesma dignidade. No sistema suplementar, a representação judicial assumiu o enfoque consumerista, consubstanciado na abusividade da cláusula limitativa da internação psiquiátrica e no direito superior à vida. O direito à saúde, vislumbrado nas decisões judiciais, resumiu-se ao direito de acesso aos serviços de saúde e ao direito à doença. A compreensão do Poder Judiciário, nos dois sistemas investigados, foi a do direito à saúde como o direito ao bem de saúde pleiteado em juízo, o que coloca muitos desafios para os sistemas de saúde e para o Poder Judiciário frente à consolidação dos ideais da reforma psiquiátrica estatuída pela Lei n. 10.216/2001.

The current research sought to present the social representations of judges from the São Paulo Court of Justice about the law regarding psychiatric admissions. Data were collected through the court website, from 184 judgments including all the decisions published between January 1998, and December 2012, regarding psychiatric admissions claimed to both the Brazilian Public Health System, and the private insurance health system. As methods, the author used descriptive statistics and the collective subject speech. The Social Representations Theory was applied as a theoretical framework to interpret the collected speeches. Considering Brazilian Public Health System, the admissions claimed on the court were compulsory and judges presented the psychiatric admissions, mostly, as a protection measure of people with mental disorders dignity and, at a lower degree, as a violence against this same dignity. With respect to the private insurance health system, the judicial representation was related to the consumerist approach, supported by the abuse of a clause restricting the time for psychiatric admissions and its contradiction with the right to life. The right to health was characterized in the decisions as the right of access to health services and the right to be ill. The comprehension of the judges in both investigated systems related the right to health to the right to a health as a good claimed in court, imposing many challenges to health systems and the Judiciary Power in order to consolidate the principles of the psychiatric reform brought by Law n. 10.216/2001.

Psychiatric Hospitalization for Attempted Suicide and Reattempt at the One-Year Follow-Up / Hospitalización Psiquiátrica por Intento de Suicidio y Reintento al Año de Seguimiento

Background: People hospitalized for suicide attempt (SA) have a high risk of repeating and committing suicide during the first months after discharge. The aim of this study is to compare the usual treatment (TAU) with a TAU supplemented with a telephone follow-up programme (TAU + T). Method: multicentre, open-trial, ex post facto pre-post prospective study that compared two samples of 90 (TAU) and 101 (TAU + T) people admitted in 2018-2019 for attempted suicide in two psychiatry units after one-year follow-up. Repeated SAs were analysed. Results: A total of 31.4% (n=60) of the sample attempted suicide at least once during follow-up, with no differences between the units. A total of 32.5% (n=62) were readmitted during the following year, 15.6% of those readmissions were due to new suicide attempts. In TAU, the highest proportion of reattempts was among those diagnosed with personality disorders (77.8%) vs. other diagnoses (28.4%). In TAU + T, the highest proportion was found among those with previous SAs (50%) vs. those admitted for the first SA (4.4%). Conclusions: people admitted to psychiatric units for a first SA seem to benefit from TAU + T as it was associated with a lower recurrence of SA after discharge.(AU)

Antecedentes: las personas hospitalizadas por un intento de suicidio (IS) tienen un riesgo alto de repetir/consumar el suicidio en los meses siguientes al alta. El objetivo de este estudio es comparar un tratamiento habitual (TAU) con un TAU complementado con un programa de seguimiento telefónico (TAU + T). Método: estudio multicéntrico, abierto, ex post-facto pre-post prospectivo de dos grupos que comparó dos muestras de 90 (TAU) y 101 (TAU+T) personas ingresadas en 2018-2019 por IS tras un año de seguimiento. Se analizó las repeticiones de los IS. Resultados: el 31,4% (n=60) realizó al menos un intento de suicidio en el seguimiento, sin diferencias entre los dos centros. El 32,5% (n=62) reingresó en el año siguiente, de ellos el 15,6% debido a nuevos intentos. En TAU, la mayor proporción de reintentos se dio entre quienes estaban diagnosticados de trastornos de personalidad (77,8%) vs. resto de diagnósticos (28.4%). En TAU + T la mayor proporción se dio entre quienes presentaban IS anteriores (50%) vs. ingresados por primer IS (4.4%). Conclusiones: las personas ingresadas en unidad de hospitalización por un primer IS, parecieron beneficiarse del TAU + T ya que se asoció a una menor recurrencia de los IS posterior al alta.(AU)

Psiquiatrización de la sexualidad femenina: a propósito de los testimonios y las historias clínicas de las mujeres del Manicomio de Leganés en el periodo 1939-1952 / Psychiatrization of female sexuality: regarding the testimonies and clinical histories of women in the Leganés Asylum in the 1939-1952 period1

En el presente trabajo investigamos sobre los testimonios escritos correspondientes a mujeres ingresadas en el antiguo Manicomio Nacional de Leganés durante la España del primer franquismo. Analizamos desde una lectura crítica feminista tanto los discursos de los psiquiatras de la época como el discurso de las propias mujeres ingresadas, ya que ambas voces conviven en el material trabajado. De esta manera, pretendemos esbozar cómo se patologizó la sexualidad de la mujer así como cualquier conducta fuera del rol de madre, mujer de la casa o mujer de vida consagrada. Este modelo de identidad femenina que se impuso en la época encontró sus vías de afianzamiento en la educación, el marco legal y la psiquiatría, principalmente. Y de ello queda constancia en los escritos que rescatamos, así como en los trabajos de investigación en que nos apoyamos. (AU)

In the present work, we investigate the written accounts of women interned in the old Leganés National Asylum in Spain during the first years of Franco´s regime. We analyze, under a critical feminist reading, the voices of both psychiatrists present at those times and the female inmates themselves, since both voices coexist in the material studied. Thus, we intend to outline how women´s sexuality was pathologized, as well as any other role that was taken outside the role of mother, woman of the house, or woman of consecrated life. This model of female identity that was imposed in those times was consolidated mainly through education, legal framework, and psychiatry. And this is evidenced in the writings that we have rescued, as well as in the research work on which we base our work. (AU)

A Study into the Operation of the Queensland Mental Health Review Tribunal.

The Queensland Mental Health Review Tribunal makes difficult decisions regarding involuntary treatment of people with mental illness, applying strict legislative criteria against a backdrop of fundamental human rights considerations. This article reports on focus group research with lawyers and advocates for people with mental illness who appear before the Queensland Mental Health Review Tribunal. Participants expressed concerns regarding the manner in which decisions are made. For example, participants said that their clients' views on the side effects of treatment do not receive adequate consideration when involuntary treatment is authorised. We review these concerns in the light of applicable legal obligations, including those arising from human rights law. We conclude that if these concerns are accurate, some adjustments to the Queensland Mental Health Review Tribunal's decision-making processes are required.

Experiences of involuntary psychiatric admission decision-making: a systematic review and meta-synthesis of the perspectives of service users, informal carers, and professionals.

BACKGROUND: In involuntary psychiatric admission, used globally, professionals or caretakers decide upon hospitalization regardless of what the person with psychosocial disabilities decides. This raises clinical, ethical, legal, and human rights concerns, and it goes against Convention on the Rights of Persons with Disabilities (CRPD). CRPD mandates that member states respect the autonomy of people with disabilities. Through Article 12, it recognizes full enjoyment of legal capacity for persons with disabilities. Implementation of Article 12 is challenging in every country, and exploring all the stakeholders' experiences at admission decision-making will help us to understand the challenges that the current psychiatry system poses for service users to exercise their autonomy and identify the areas where service users need support to have their rights, will, and preferences respected. AIM: To describe the experiences of service users, informal carers, and professionals in involuntary psychiatric admission decision-making and throughout the subsequent involuntary admission. We explored the support that the service users need to have their rights, will, and preferences respected. METHOD: A search of twelve databases in medicine, sociology, and law in Danish, English, Japanese, Norwegian, Portuguese, Spanish, and Swedish was conducted in 2017 and 2018, limited to the past 10 years, using terms such as "involuntary," "admission," "mental illness," and "experience". The search identified 682 articles. Four researchers independently reviewed the articles to find those that completed original qualitative or mixed method studies exploring experiences of involuntary psychiatric admission among adults. We added seven publications from the articles' references, contacted experts in the field (no publications were added), and excluded two articles that were in German. Three researchers analyzed the articles' results using Thematic Analysis (PROSPERO registration number CRD42019072874). RESULTS: Overall, 37 articles were included from 11 countries; they involved 731 service users, 100 informal carers, and 291 mental health professionals. We identified a lack of communication and a power imbalance among the stakeholders, which was exacerbated by the professionals' attitudes. At admission decision-making, the service users wanted to be heard and wanted to understand the situation. The families felt responsibility for the service users, they were careful not to ruin relationships, and they struggled to obtain support from the mental health system. Professionals believed that threats or harming others should lead to admission regardless of what the service users or their families felt. Professionals sometimes felt that it was not necessary to explain the information to the service users because they would not understand. Professionals were concerned and frustrated with difficulties in coordinating among themselves. During admission, service users struggled with the ward environment and relationship with staff; they most objected to coercion, such as forced medication. Families were frustrated that they were not involved in the treatment planning, especially as the service users moved toward discharge. The professionals often rationalized that coercion was necessary, and they believed that they knew what was best for the service users. CONCLUSIONS: A lack of communication and a power imbalance among the stakeholders hindered respect for the service users' rights, will, and preferences. This was exacerbated by professionals rationalizing coercion and assuming that service users were incapable of understanding information. Services that encourage communication and overcome power imbalances (e.g. Crisis Plans, Family Group Conferencing) combined with stronger community mental health support will respect service users' rights, will, and preferences and avoid substituted decision-making on issues such as involuntary admission and forced medication.

Psychiatric commitment under the criminal law in China: An empirical perspective.

This article examines the legislation and practice of compulsory treatment in China. Part I traces the Chinese history of criminal commitment law, explains the research methodology, and highlights some general empirical findings. Part II provides a comprehensive empirical analysis of compulsory treatment law in China, it covers both substantial issues such as criteria of compulsory treatment and procedural issues such as the commitment hearing, enforcement, and discharge of compulsory treatment. It also explores the compulsory treatment law from the human rights protection perspective. Our primary objective is to present the empirical findings to enable the legislative and other involved government agencies to make informed decisions about the future evolution of Chinese law in this area.

The Connecticut Experience with Sell Legislation.

Since 2004, Connecticut has had two different mechanisms for involuntary medication of defendants hospitalized for restoration of competence to stand trial. In this article, we first describe the development of these two mechanisms and compare their procedural elements. The first procedure required a hearing in criminal court, in a process parallel to the subsequent U.S. Supreme Court holding in Sell v. United States; the later procedure uses a civil mechanism in probate court and was enacted in response to the dicta in Sell regarding the preferential use of alternate mechanisms for involuntary medication orders. To compare the effectiveness and efficiency of the two mechanisms, we examined 1,455 admissions to the state's secure forensic hospital for competency restoration for the calendar years 2005 through 2011. Petitions for involuntary medication of defendants were filed in five cases in criminal court (0.3%) and in 177 cases (12.2%) in probate court. The probate mechanism resulted in a significantly shorter duration of the resolution of the competence matter. Both mechanisms were effective at restoring defendants' competency (i.e., two thirds were restored by the criminal court process, and nearly 74% were restored in the civil process).

Is consent causing confusion for clinicians? A survey of child and adolescent Mental health professional's confidence in using Parental Consent, Gillick Competence and the Mental Capacity Act.

All professionals engaged in clinical work should be competent to assess consent for the interventions they provide. This study assesses CAMHS clinicians confidence and knowledge in the various forms of consent and the number of minors admitted to mental health units in England under parental consent alone.An online questionnaire using vignettes of possible scenarios was sent to child and adolescent mental health practitioners in Tees Esk and Wear Valleys Trust. A freedom of information request was used to determine the number of young people admitted through parental consent.Thirteen of the 20 trusts contacted had no knowledge of the number of young people admitted under parental consent. A total of 93 participants completed the survey. Out of six vignettes, there were two where the majority of responses were discordant with current legal advice. Both of these vignettes considered the use of parental consent for admission to a mental health unit.This study provides further evidence to indicate that the current consent processes in CAMHS causes confusion for clinicians. There continues to be very few safeguards for children admitted under parental consent, with most trusts in England and Wales having no centralised knowledge of whether this is occurring and the numbers involved if it is.

[Involuntary detention and seclusion measures in psychiatry: Where are we now? A regional Centre-Val de Loire 2012-2017 study]. / Soins sans consentement et mesures d'isolement en psychiatrie adulte : où en est-on ? L'exemple de la région Centre-Val de Loire via le Programme de médicalisation des systèmes d'information 2012­2017.

BACKGROUND: The French legal framework in psychiatry for involuntary detention (ID) and seclusion measures was modified in 2011 and 2016, respectively. This study aimed to describe the evolution of ID and seclusion measures in the Centre-Val de Loire region (CVL France) between 2012 and 2017, using the psychiatric hospital discharge database. METHODS: A cross-sectional study was conducted, including adult patients (≥ 18 years old) from CVL hospitalized in psychiatry or included in a care program (outpatient care) between 2012 and 2017. Hospital stays for each patient were identified by an anonymized number. RESULTS: In 2017 in CVL, 13,942 patients were hospitalised for psychiatric reasons, with 2378 in ID (17%), a proportion that has remained stable since 2012. Among them, 3% were in care due to imminent danger (+ 54% since 2013, stabilisation since 2016), and 11% were hospitalized following a third party request (-13%). However, regarding location results varied from one department to the next. Seclusion measures involved 10% of full-time patients (stable), 27% of ID patients and 3% of those under voluntary care (stable). One quarter of the secluded patients were in voluntary care. Mean seclusion duration was 12 days, consecutive or not, and somewhat less for patients in voluntary care alone (10 days). CONCLUSION: The region wide ID rate and average duration of seclusion were lower than the nationwide rate (24% in full-time ID in 2015; 15 days of seclusion/patient), whereas the number of imminent danger procedures increased, as did the persistence of seclusion measures for patients in voluntary care (recommended only as a last resort and/or for ID patients). These results should lead to renewed assessment of care center practices. The French psychiatric hospital discharge database has several limitations, including lack of financial incentive and highly complex structuration. However, since 2018 new data regarding seclusion and restraint measures have been added to the existing registry, and they should facilitate more accurate analyses, particularly as concerns restraint.

Italian Law no. 219/2017: consequences on the informed consent of the psychiatric patient and on the therapeutic privilege.

1Department of Anatomical, Histological, Forensic and Orthopaedic Sciences, Sapienza University of Rome.

Seclusion, restraint, and involuntary medication in Finnish psychiatric care: a register study with root-level data.

Purpose: Despite potentially harmful effects, seclusion, restraint, and involuntary medication continue to be frequently applied in psychiatric care. These restrictive measures are often examined by means of registers, but homogeneous practices in the measurement and description seem to be missing. This nationwide register study aimed to examine the use of seclusion, mechanical and physical restraint, and involuntary medication in Finland.Material and methods: Root-level register data concerning the year 2017 were collected directly from 140 inpatient psychiatric wards within 21 organizations. The data were analyzed statistically.Results: In 2017, the most used restrictive measure in Finnish psychiatric wards was seclusion (4006 episodes), followed by involuntary medication (2187 episodes), mechanical restraint (2113 episodes) and physical restraint (1064 events). Similarly, the duration of seclusion episodes was longer than the duration of restraint episodes. Remarkable variation between wards in the use of seclusion, restraint and involuntary medication was observable. A negative binomial regression model (NB2) was used to analyze the associations between the use of restrictive measures and regional variables concerning demography, health, substance abuse, and socio-economic status, but reliable interpretations were impossible to generate.Conclusion: This study provides detailed and unique data on the use of seclusion, restraint and involuntary medication in Finland. Compared to previous national-level data, this study highlights the importance of collecting root-level data. Future research should use registries and describe the associations between the use of restrictive measures and ward-level factors, patient-level characteristics, and societal factors.