title: Preventing Compulsory Admission to Psychiatric Inpatient Care: Perceived Coercion, Empowerment, and Self-Reported Mental Health Functioning after 12 Months of Preventive Monitoring.
abstract: OBJECTIVE
  To evaluate the effects of a preventive monitoring program targeted to reduce compulsory rehospitalization and perceived coercion in patients with severe mental disorder. We analyze patient outcomes in terms of perceived coercion, empowerment, and self-reported mental health functioning at 12 months.
  
  
  METHODS
  The program consists of individualized psychoeducation, crisis cards and, after discharge from the psychiatric hospital, a 24-month preventive monitoring. In total, 238 psychiatric inpatients who had had compulsory admission(s) during the past 24 months were included in the trial. T1-assessment 12 months after baseline was achieved for 182 patients.
  
  
  RESULTS
  Study participants reported lower levels of perceived coercion, negative pressures, and process exclusion, a higher level of optimism, and a lesser degree of distress due to symptoms, interpersonal relations, and social role functioning (significant time effects). However, improvements were not confined to the intervention group, but seen also in the treatment-as-usual group (no significant group or interaction effects). Altered perceptions were linked to older age, shorter illness duration, female sex, non-psychotic disorder, and compulsory hospitalization not due to risk of harm to others.
  
  
  CONCLUSIONS
  Our findings suggest that changes in the subjective perspective were fueled primarily by participation in this study rather than by having received the specific intervention. The study contributes to a better understanding of the interaction between "objective" measures (compulsory readmissions) and patients' perceptions and highlights the need for treatment approaches promoting empowerment in individuals with a history of involuntary psychiatric hospitalizations.
authors.affiliation: Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland.
authors.forename: Barbara
authors.initials: B
authors.lastname: Lay
authors.affiliation: The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland.
authors.forename: Thekla
authors.initials: T
authors.lastname: Drack
authors.affiliation: The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland.
authors.forename: Marco
authors.initials: M
authors.lastname: Bleiker
authors.affiliation: The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland.
authors.forename: Silke
authors.initials: S
authors.lastname: Lengler
authors.affiliation: The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland.
authors.forename: Christina
authors.initials: C
authors.lastname: Blank
authors.affiliation: Department for Psychiatry, Psychotherapy and Psychosomatics, University Hospital of Psychiatry Zurich , Zurich , Switzerland ; The Zurich Program for Sustainable Development of Mental Health Services (ZInEP), University Hospital of Psychiatry Zurich , Zurich , Switzerland ; Laboratory of Neuroscience (LIM27), Institute of Psychiatry, University of São Paulo , São Paulo , Brazil.
authors.forename: Wulf
authors.initials: W
authors.lastname: Rössler
keywords: compulsory hospitalization; empowerment; evaluation; perceived coercion; prevention