title: Impact of psychiatrists' qualifications on the rate of compulsory admissions.
abstract: Despite efforts to reduce coercion in psychiatry, involuntary hospitalizations remain frequent, representing more than half of all admissions in some European regions. Since October 2006, only certified psychiatrists are authorized to require a compulsory admission to our facility, while before all physicians were, including residents. The aim of the present study is to assess the impact of this change of procedure on the proportion compulsory admissions. All medical records of patients admitted respectively 4 months before and 4 month after the implementation of the procedure were retrospectively analyzed. This search retrieved a total of 2,227 hospitalizations for 1,584 patients. The overall proportions of compulsory and voluntary admissions were 63.9 % and 36.1 % respectively. The average length of stay was 32 days (SD ± 64.4). During the study period, 25 % of patients experienced two hospitalizations or more. The most frequent patients' diagnoses were affective disorders (30 %), psychotic disorders (18.4 %) and substance abuse disorders (15.7 %). Compared with the period before October 2006, patients hospitalized from October 2006 up were less likely to be hospitalized on a compulsory basis (OR = 0.745, 95 % CI: 0.596-0.930). Factors associated with involuntary admission were young age (20 years or less), female gender, a diagnosis of psychotic disorder and being hospitalized for the first time. Our results strongly suggest that limiting the right to require compulsory admissions to fully certified psychiatrists can reduce the rate of compulsory versus voluntary admissions.
authors.affiliation: Division of Prison Psychiatry, Department of Mental Health and Psychiatry, University Hospitals of Geneva, 2 Chemin du Petit-Bel-Air, 1225 Geneva, Switzerland. Ariel.Eytan@hcuge.ch
authors.forename: Ariel
authors.initials: A
authors.lastname: Eytan
authors.forename: Anne
authors.initials: A
authors.lastname: Chatton
authors.forename: Edith
authors.initials: E
authors.lastname: Safran
authors.forename: Yasser
authors.initials: Y
authors.lastname: Khazaal
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002568:Certification; D003068:Coercion; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data / Q000639:trends*; D006778:Hospitals, Psychiatric / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D011570:Psychiatry / Q000592:standards*; D012149:Restraint, Physical / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D013557:Switzerland / Q000453:epidemiology; D055815:Young Adult