Impact of Psychiatrists’ Qualifications on the Rate of Compulsory Admissions

Despite efforts to reduce coercion in psychiatry, involuntary hospitalizations remain frequent, representing more than half
of all admissions in some European regions. Since October 2006, only certified psychiatrists are authorized to require a compulsory
admission to our facility, while before all physicians were, including residents. The aim of the present study is to assess
the impact of this change of procedure on the proportion compulsory admissions. All medical records of patients admitted respectively
4 months before and 4 month after the implementation of the procedure were retrospectively analyzed. This search retrieved
a total of 2,227 hospitalizations for 1,584 patients. The overall proportions of compulsory and voluntary admissions were
63.9 % and 36.1 % respectively. The average length of stay was 32 days (SD ± 64.4). During the study period, 25 % of patients
experienced two hospitalizations or more. The most frequent patients’ diagnoses were affective disorders (30 %), psychotic
disorders (18.4 %) and substance abuse disorders (15.7 %). Compared with the period before October 2006, patients hospitalized
from October 2006 up were less likely to be hospitalized on a compulsory basis (OR = 0.745, 95 % CI: 0.596–0.930). Factors
associated with involuntary admission were young age (20 years or less), female gender, a diagnosis of psychotic disorder
and being hospitalized for the first time. Our results strongly suggest that limiting the right to require compulsory admissions
to fully certified psychiatrists can reduce the rate of compulsory versus voluntary admissions.