Variations in involuntary commitment in the European Union

C. L. Mulder

Mental Health Group Europoort, Municipal Health Service Rotterdam, Erasmus Medical Centre, Barendrecht, The Netherlands. E-mail: niels.clmulder{at}wxs.nl

EDITED BY KHALIDA ISMAIL

The recent article by Salize & Dressing (2004) reported that frequencies of compulsory admissions vary remarkably among countries in the European Union, from 6 per 100 000 citizens in Portugal to 218 per 100 000 in Finland. These findings are not surprising given the large differences in the laws, mental health acts, and legal instruments of the countries but they are astonishing given the much smaller differences in psychiatric morbidity. These differences show that the number of involuntary admissions is a result of a complex set of still poorly understood legal, political, economic, social and multiple other factors (Salize et al, 2002). However, data on the effectiveness of coercion measures are lacking and there is no evidence base for involuntary commitment. The few studies have focused mainly on out-patient commitment and show mixed results (Swanson et al, 2000; Steadman et al, 2001; Swanson et al, 2003).

The absence of an evidence-based model for the use of coercion in psychiatry is partly due to ethical difficulties in studying coercion measures, for example, using randomised controlled trails. We need to find ways to overcome these difficulties, for example by assessing the effectiveness of involuntary admission in those who pose relatively little danger to themselves and others. Results of these studies need to be taken into account in the current debate on the use of coercion measures. It is likely that certain groups of patients benefit more from specific coercion measures than others. Patients with psychotic disorders with severe social breakdown and lack of motivation for treatment probably benefit more from cerocion measures than those with personality disorders. International comparative studies are needed to assess the effects of different laws on outcomes, for example laws using criteria of danger v. those using need for treatment criteria. Valid and reliable instruments are needed when deciding to use coercion; these should include assessment of the severity of psychiatric disorder, danger to self or others and motivation for treatment. Researchers active in this field could form collaborative (inter)national working groups on pressure for treatment and coercion in psychiatry.

REFERENCES

Salize, H.J., Dressing, H. (2004) Epidemiology of involuntary placement of mentally ill people across the European Union. British Journal of Psychiatry, 184, 163 -168.[Abstract/Free Full Text]

Salize, H.J., Dressing, H. & Peitz, M. (2002) Compulsory Admission and Involuntary Treatment of Mentally Ill Patients - Legislation and Practice in EU-Member States. Final Report. Mannheim: Central Institute of Mental Health. Available at http://europa.eu.int/comm/health/ph_projects/2000/promotion/fp_promotion_2000_frep_08_en.pdf

Steadman, H. J., Gounis, K., Dennis, D., et al (2001) Assessing the New York City involuntary outpatient commitment pilot program. Psychiatric Services, 52, 330 -336.[Abstract/Free Full Text]

Swanson, J.W., Swartz, M. S., Wagner, H. R., et al (2000) Involuntary out-patient commitment and reduction of violent behaviour in persons with severe mental illness. British Journal of Psychiatry, 176, 324 -331.[Abstract/Free Full Text]

Swanson, J.W., Swartz, M. S., Elbogen, E. B., et al (2003) Effects of involuntary outpatient commitment on subjective quality of life in persons with severe mental illness. Behavioral Sciences and the Law, 21, 473 -491.[CrossRef][Medline]





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