title: Involuntary psychiatric admission: Characteristics of the referring doctors and the doctors' experiences of being pressured.
abstract: BACKGROUND
  In Norway, doctors may make the decision to refer patients to involuntary psychiatric treatment. This is a difficult decision, as it involves a range of medical, legal and ethical challenges. The decision to commit is presumed based on an independent assessment of the patient and whether a set of medico-legal criteria is met.
  
  
  OBJECTIVE
  To examine characteristics of GPs that admitted patients involuntarily to a psychiatric hospital, and to examine how the GPs assessed this process.
  
  
  METHODS
  74 doctors who had referred patients to involuntary admission at one major Norwegian psychiatric hospital participated in semi-structured interviews. The questions posed were in part factual and in part about the participating doctors' assessments and considerations with respect to the involuntary admission of psychiatric patients.
  
  
  RESULTS
  Approximately half of the participating doctors worked at the public out-of-hours clinics, while a fifth were the patients' family doctors. Those working at the out-of-hours clinics had less work experience and fewer had prior knowledge of the patients they committed. About half the doctors felt it was difficult to apply the medico-legal criteria. More than half had felt pressured/advised to refer the patient to hospital and about half had felt pressured/advised to do so involuntarily.
  
  
  CONCLUSIONS
  While doctors considering the commitment of psychiatric patients are presumed to make independent assessments of patients based on medico-legal criteria, this study suggests that many doctors feel pressured to commit.
  
  
  CONCLUSIONS
  The assessment made by doctors who refer patients involuntarily to psychiatric hospital may be influenced by other parts of the health service, the patient's family and the police. Many doctors feel that it is difficult to apply the medico-legal criteria when referring patients involuntarily.
authors.affiliation: Ketil Røtvold, M.D., Division of Addictions and Specialized Psychiatric Services, University Hospital of North Norway, Tromsø, and Department of Clinical Medicine , UiT-The Arctic University of Norway, Tromsø , Norway.
authors.forename: Ketil
authors.initials: K
authors.lastname: Røtvold
authors.forename: Rolf
authors.initials: R
authors.lastname: Wynn
mesh_terms: D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence / Q000592:standards*; D005260:Female; D058005:General Practitioners / Q000331:legislation & jurisprudence / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D012017:Referral and Consultation / Q000592:standards*
keywords: Commitment; Doctors; Health services; Involuntary admission; Psychiatry