Acute Inpatients Units’ Old New Challenges: Compulsory Versus Voluntary Treatment

Abstract

Background:

Besides preventive, maintenance and rehabilitative measures, it is very important that Psychiatry Services develop acute care interventions that include hospitalization treatments. Compulsory treatment is mandatory when patients have a severe mental illness that deprives them from their judgement abilities in such a way that they deny their illness, refuse necessary treatment, and may endanger themselves and/or others.

Aims:

To compare socio-demographic and clinical features of patients treated in compulsory and voluntary regimen. To make a reflection on the most suitable model for the acute inpatient services.

Methods:

Retrospective study of socio-demographic and clinical characteristics of patients admitted in an acute inpatients’ unit of a Psychiatric Hospital - Hospital de Magalhães Lemos - in 2006 and 2007. We compared data of compulsory (CA) and voluntary admissions (VA), and discuss their respective main problems.

Results:

Among the total 577 inpatients admitted, 13% were compulsory and 87% were voluntary. Schizophrenia was the most prevalent diagnosis in both groups (51% CA vs 26% VA). By discharge, prescription of depot antipsychotics was higher in CA, and treatment with antidepressants was higher in VA. In CA, 8 (11%) patients had discharge against medical advice (escape) vs 12 (2%) in VA.

Conclusion:

Results might suggest that the current facilities and/or procedures are not sufficient to offer the levels of protection needed to provide the best environment for patients’ recovery.

In the context of the recent efforts towards the reorganization of mental health services, specific measures should be considered, including acute inpatients units exclusively designed for CA.