Involuntary admission may support treatment outcome and motivation in patients receiving assertive community treatment.
OBJECTIVE
Patients with severe mental illness who are treated in assertive community treatment (ACT) teams are sometimes involuntarily admitted when they are dangerous to themselves or others, and are not motivated for treatment. However, the consequences of involuntary admission in terms of psychosocial outcome and treatment motivation are largely unknown. We hypothesized that involuntary admission would improve psychosocial outcome and not adversely affect their treatment motivation.


METHODS
In the context of routine 6-monthly outcome monitoring in the period January 2003-March 2008, we used the Health of the Nation Outcome Scales (HoNOS) and a motivation-for-treatment scale to assess 260 severely mentally ill patients at risk for involuntary admission. Mixed models with repeated measures were used for data analyses.


RESULTS
During the observation period, 77 patients (30%) were involuntarily admitted. Relative to patients who were not involuntarily admitted, these patients improved significantly in HoNOS total scores (F = 17,815, df = 1, p < 0.001) and in motivation for treatment (F = 28.139, df = 1, p < 0.001). Patients who were not involuntarily admitted had better HoNOS and motivation scores at baseline, but did not improve.


CONCLUSIONS
Involuntary admission in the context of ACT was associated with improvements in psychosocial outcome and motivation for treatment. There are no indications that involuntary admission leads to deterioration in psychosocial outcome or worsening of motivation for treatment.
BavoEuropoort, Westersingel 94, 3015 LC, Rotterdam, The Netherlands. h.kortrijk@bavo-europoort.nl
Hans Erik
HE
Kortrijk
A B P
AB
Staring
A W B
AW
van Baars
C L
CL
Mulder
D000328:Adult; D000553:Ambulatory Care / Q000331:legislation & jurisprudence; D001242:Assertiveness; D001294:Attitude to Health; D001521:Behavior Therapy / Q000379:methods*; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence; D003156:Community Mental Health Services; D003617:Dangerous Behavior; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000150:complications / Q000523:psychology / Q000628:therapy*; D009042:Motivation; D009426:Netherlands; D011569:Psychiatric Status Rating Scales / Q000706:statistics & numerical data; D016896:Treatment Outcome