Preventing involuntary admissions: special needs for distinct patient groups.
BACKGROUND
Coercive measures in psychiatry are a controversial topic and raise ethical, legal and clinical issues. Involuntary admission of patients is a long-lasting problem and indicates a problematic pathway to care situations within the community, largely because personal freedom is fundamentally covered by the UN declaration of human rights and the German constitution.


METHODS
In this study, a survey on a large and comprehensive population of psychiatric in-patients in the eastern part of North Rhine-Westphalia, Germany, was carried out for the years 2004-2009, including 230.678 treatment cases. The data were collected from the dataset transferred to health insurance automatically, which, since 2004 is available in an electronic form. In addition, a wide variety of information on treatment, sociodemographic and illness-related factors were collected and analysed. Data were collected retrospectively and analyses were calculated using statistical software (IBM SPSS Statistics 19.0®). Quantitative data are presented as mean and standard deviation. Due to the unequal group sizes, group differences were calculated by means of Chi-square tests or independent samplettests. A Bonferroni correction was applied to control for multiple comparisons.


RESULTS
We found an over-representation of involuntary admissions in young men (<21 years) suffering from schizophrenia and in female patients aged over 60 with a diagnosis of dementia. Most of our results are concordant with the previous literature. Also admission in hours out of regular out-patient services elevated the risk.


CONCLUSIONS
The main conclusion from these findings is a need for a fortification of ambulatory treatment offers, e.g. sociopsychiatric services or ward round at home for early diagnosis and intervention. Further prospective studyies are needed.
Dept. of Psychiatry, LWL Institute of Mental Health, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr.1, 44791 Bochum, Germany.|Department of Psychiatry, LWL-University Hospital Bochum, Alexandrinenstr. 1, 44791 Bochum, Germany.
Knut
0000-0001-6263-5595
K
Hoffmann
Dept. of Psychiatry, LWL Institute of Mental Health, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr.1, 44791 Bochum, Germany.
I S
IS
Haussleiter
Dept. of Psychiatry, LWL Institute of Mental Health, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr.1, 44791 Bochum, Germany.|Department of Psychiatry, LWL-University Hospital Bochum, Alexandrinenstr. 1, 44791 Bochum, Germany.
F
F
Illes
Dept. of Psychiatry, LWL Institute of Mental Health, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr.1, 44791 Bochum, Germany.|Department of Psychiatry, LWL-University Hospital Bochum, Alexandrinenstr. 1, 44791 Bochum, Germany.
J
J
Jendreyschak
NRW Center for Health, Gesundheitscampus 9, 44801 Bochum, Germany.
A
A
Diehl
Dept. of Psychiatry, LWL Institute of Mental Health, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr.1, 44791 Bochum, Germany.
B
B
Emons
Dept. of Psychiatry, LWL Institute of Mental Health, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr.1, 44791 Bochum, Germany.
C
C
Armgart
Dept. of Psychiatry, LWL Institute of Mental Health, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr.1, 44791 Bochum, Germany.
A
A
Schramm
Dept. of Psychiatry, LWL Institute of Mental Health, LWL University Hospital, Ruhr-University Bochum, Alexandrinenstr.1, 44791 Bochum, Germany.|Department of Psychiatry, LWL-University Hospital Bochum, Alexandrinenstr. 1, 44791 Bochum, Germany.
G
G
Juckel
Coercion; Involuntary admission; Legal basics