Involuntary Inpatient Treatment

There are times when a person with severe mental illness may be compelled to seek mental health treatment against his or her will. State commitment laws vary (see treatment.html), but the criteria for involuntary commitment are markedly similar across state lines. In a court hearing, the laws require that it must be determined that an individual is mentally ill, and as a result of the illness the individual poses a real and present threat to harm of self or others. Because of mental illness, the individual is not able to make a rational and informed decision on whether treatment is needed. Moreover, if not treated, the individual will continue to suffer from mental distress and the inability to function independently.

The outcome of involuntary hospital commitment has been reported in two systematic reviews and a multi-site study involving a large sample. In the review conducted by Katsakou and Priebe (2006), most studies of involuntary psychiatric hospital admissions reported that the majority of patients showed marked clinical improvement, and patients with greater clinical improvement had more positive assessments of the value of the hospitalization experience at follow-up. Importantly, a substantial number of involuntary patients did not feel that their hospital admission was either justified or helpful.

In a systematic review of studies of outcome diversity among involuntary and voluntary hospital admissions, Kallert et al. (2008) observed that most studies reported that involuntary patients had greater lengths of stay, a higher readmission risk, greater risk for suicide, lower levels of social functioning, greater dissatisfaction with treatment, and greater questioning of the need for hospitalization.

In a large European multi-site study of legally coerced patients and patients admitted voluntarily who felt coerced, Kallert et al. (2011) noted that symptom levels in both groups markedly improved over a three month follow-up period. Diagnosis was not a factor in symptom improvement. Greater symptoms at baseline, being unemployed, living alone, having a history of repeated hospitalizations, being a voluntary patient who felt coerced, and less satisfaction with treatment were associated with less symptom improvement. The limited symptom improvement found among coerced patients is possibly accounted for by the severity of their underlying disorders.

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