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05-05-2010 | Mental health | Article

National legislation differences affect patients’ views on involuntary admission


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MedWire News: Psychiatric patients’ retrospective views on involuntary hospital admission (IHA) vary significantly between different European countries, research indicates.

“The size of these differences are substantial, and many of them are statistically significant,” says Stefan Priebe, from Barts’ and the London School of Medicine and Dentistry, Queen Mary University of London in the UK, and colleagues.

“This variation is not explained by differences in sociodemographic characteristics, clinical diagnoses, or baseline symptom levels,” they add.

The researchers assessed patients’ views on IHA after 1 and 3 months at sites in 11 European countries (Bulgaria, Czech Republic, Germany, Greece, Italy, Lithuania, Poland, Slovakia, Spain, Sweden, and the UK).

Of 2326 patients, 62% were diagnosed with schizophrenia.

One month after IHA between 39 and 71% of patients believed the admission was right. After 3 months, when the acute phase of the mental illness justifying the involuntary admission has been overcome in most patients, the rates were higher, at between 46 and 86%.

Women, those living alone, and those with a diagnosis of schizophrenia had more negative views. Adjusting for confounding factors, differences between countries remained significant.

Writing in the British Journal of Psychiatry, the researchers conclude that “there is no straightforward answer” to the question: “Can identified differences in patients’ views... be linked to the characteristics of a country’s legislation?”

However, they propose a possible link with the extent to which national regulations protect the rights and interests of the patients. Seven criteria seen as relevant for the protection of patients’ interests differed between countries. And ranking of the countries based on the number of criteria was similar to the outcome of the multivariate analysis –the most protective legislation and most positive patient views were in Slovakia and Germany, and the least protective legislation and most negative views in England.

Other possible factors include geographical position and political history, and the relative expenditure of healthcare on mental healthcare, but none of these factors were clearly associated with differences in patients’ views in the study.

The researchers suggest: “Future in-depth studies could identify those factors in legislation and practice that are specifically relevant to achieving more positive views from patients. Countries with currently less favorable outcomes, such as England, might consider implementing them, and methods may be developed to strengthen these factors and improve outcomes across all countries.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Joel Levy

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