Skip to main content

Advertisement

SpringerLink
Log in

Compulsory admissions and preferences in decision-making in patients with psychotic and bipolar disorders

  • Original Paper
  • Published:
Social Psychiatry and Psychiatric Epidemiology Aims and scope Submit manuscript

Abstract

Purpose

Participation in medical decisions and taking into account patients’ values and preferences are especially important for psychiatric patients who may be treated against their will. The increasing rates of coercive measures and the underlying clinical, ethical, and legal issues highlight the need to examine their use in psychiatry. Although limited congruence in decision-making preferences may be on the basis of these coercive practices, this issue has not been adequately addressed. We explore the relationship between compulsory admissions and congruence in decision-making preferences in mental health settings.

Methods

Cross-sectional study among 107 outpatients with DSM diagnoses of schizophrenia of bipolar disorder using the Control Preference Scale to assess congruence in decision-making experienced and preferred style. History of compulsory admissions was obtained through review of available records. Descriptive statistics and multivariate analyses were used.

Results

70% of patients reported experiencing their preferred style of decision-making and 44% patients had history of compulsory admissions. These patients were more autonomous and preferred to take a more active role. The degree of congruence was lower in patients with previous compulsory admissions. The best predictors of compulsory admissions were not having a regular doctor and the unmatched participation preferences.

Conclusions

Patients who experienced a different level of participation in decision-making than desired more frequently had compulsory admissions. We propose to assess participation preferences each time a relevant treatment decision is about to be made and tailor care accordingly. We identified several factors leading to compulsory admissions that can be modified to prevent further coercive measures.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. European Parliament and the Council of the European Union. Convention for the protection of human rights and dignity of the human being with regard to the application of biology and medicine: convention on human rights and biomedicine. 4. 1997. European Treaty Series. No. 164 https://rm.coe.int/1680084824. Accessed 01 May 2019

  2. Official State Gazette (2002) Law 41/2002, of 14 November, regulating patient autonomy and rights and obligations of information and clinical documentation. 274, 40126–40132

  3. Official State Gazette (2000) Law 1/2000, of 7 January on civil procedure. Article 763 compulsory internment due to psychic disorder. 7 708

  4. Kallert TW, Glöckner M, Onchev G, Raboch J, Karastergiou A, Solomon Z, Magliano L, Dembinskas A, Kiejna A, Nawka P, Torres-Gonzales F, Priebe S, Kjellin L (2005) The EUNOMIA project on coercion in psychiatry: study design and preliminary data. World Psychiatr 4:168–172

    Google Scholar 

  5. Lay B, Kawohl W, Rössler W (2019) Predictors of compulsory re-admission to psychiatric inpatient care. Front Psychiatr 10:120. https://doi.org/10.3389/fpsyt.2019.00120

    Article  Google Scholar 

  6. Sashidharan SP, Saraceno B (2017) Is psychiatry becoming more coercive? BMJ 357:j2904. https://doi.org/10.1136/bmj.j2904

    Article  PubMed  CAS  Google Scholar 

  7. Rodríguez-Jiménez J. UHB Map Project. III Jornada de Unidades de Hospitalización Breve. 2018. Valencia. http://isanidad.com/127753/el-60-de-los-ingresos-en-unidades-de-hospitalizacion-breve-de-psiquiatria-son-voluntarios/. Accessed 05 Jun 2019

  8. Asociación Española de Neuropsiquiatría. Manifiesto de Cartagena. XXXVI Jornadas de la AEN. 2016. Cartagena. https://aen.es/blog/2016/06/05/manifiesto-en-torno-a-la-coercion-en-los-servicios-de-salud-mental/. Accessed 28 May 2019

  9. Comité Jurídico de Confederación SALUD MENTAL ESPAÑA (2018) Informe sobre el estado de los DERECHOS HUMANOS de las personas con trastorno mental en España 2017. Licencia de contenidos Creative Commons: Reconocimiento—No Comercial (by-nc), Madrid

  10. Mendez J (2013) Report of the Special Rapporteur on torture and other cruel, inhuman or degrading treatment or punishment. United Nations: Human Rights Council, 22nd session. http://daccess-dds-ny.un.org/doc/UNDOC/GEN/G13/105/77/PDF/G1310577.pdf?OpenElement. Accessed 01 Mar 2019

  11. Zinkler M (2019) Supported decision making in the prevention of compulsory interventions in mental health care. Front Psychiatr 10:137. https://doi.org/10.3389/fpsyt.2019.00137

    Article  Google Scholar 

  12. Metz MJ, Veerbeek MA, Twisk WR, van der Feltz-Cornelis CM, de Beurs E, Beekman AT (2019) Shared decision-making in mental health care using routine outcome monitoring: results of a cluster randomised-controlled trial. Soc Psychiatr Psychiatr Epidemiol 54:209–219. https://doi.org/10.1007/s00127-018-1589-8

    Article  Google Scholar 

  13. Metz MJ, Veerbeek MA, van der Feltz-Cornelis CM, de Beurs E, Beekman AT (2018) Decisional conflict in mental health care: a cross-sectional study. Soc Psychiatr Psychiatr Epidemiol 53:161–169. https://doi.org/10.1007/s00127-017-1467-9

    Article  Google Scholar 

  14. Valenti E, Banks C, Calcedo-Barba A, Bensimon CM, Hoffmann KM, Pelto-Piri V, Jurin T, Márquez-Mendoza O, Mundt AP, Rugkasa J, Tubini J, Priebe S (2015) Informal coercion in psychiatry: a focus group study of attitudes and experiences of mental health professionals in ten countries. Soc Psychiatr Psychiatr Epidemiol 50:1297–1308. https://doi.org/10.1007/s00127-015-1032-3

    Article  Google Scholar 

  15. de las Cuevas C, Peñate W, de Rivera L (2014) Psychiatric patients’ preferences and experiences in clinical decision-making: examining concordance and correlates of patients’ preferences. Patient Educ Couns 96:222–228. https://doi.org/10.1016/j.pec.2014.05.009

    Article  Google Scholar 

  16. Morán-Sánchez I, Gómez-Vallés P, Bernal-López MA, Pérez-Cárceles MD (2019) Shared decision making in outpatients with mental disorders: patients’ preferences and associated factors. J Eval Clin Pract. https://doi.org/10.1111/jep.13246

    Article  PubMed  Google Scholar 

  17. Hamann J, Mendel R, Schebitz M, Reiter S, Búhner M, Cohen R, Berthele A, Kissling W (2010) Can psychiatrists and neurologists predict their patients’ participation preferences? J Nerv Ment Dis 198:309–311. https://doi.org/10.1097/NMD.0b013e3181d6128c

    Article  PubMed  Google Scholar 

  18. Hamann J, Kohl S, McCabe R, Bühner M, Mendel R, Albus M (2016) What can patients do to facilitate shared decision making? A qualitative study of patients with depression or schizophrenia and psychiatrists. Soc Psychiatr Psychiatr Epidemiol 51:617–625. https://doi.org/10.1007/s00127-015-1089-z

    Article  Google Scholar 

  19. Sells D, Davidson L, Jewel C, Falzer P, Rowe M (2006) The treatment relationship in peer-based and regular case management for clients with severe mental illness. Psychiatr Serv 57:1179–1184

    Article  Google Scholar 

  20. Indu NV, Vidhukumar K, Sarma PS (2018) Determinants of compulsory admissions in a state psychiatric hospital–case control study. Asian J Psychiatr 35:141–145. https://doi.org/10.1016/j.ajp.2016.11.007

    Article  PubMed  Google Scholar 

  21. Oliva F, Ostacoli L, Versino E, Portigliatti Pomeri A, Furlan PM, Carletto S, Picci RL (2019) Compulsory psychiatric admissions in an italian urban setting: are they actually compliant to the need for treatment criteria or arranged for dangerous not clinical condition? Front Psychiatr 9:740. https://doi.org/10.3389/fpsyt.2018.00740

    Article  Google Scholar 

  22. American Psychiatric Association (2014) Diagnostic and statistical manual of mental disorders. American Psychiatric Publishing, Washington

    Google Scholar 

  23. Lobo A, Saz P, Marcos G, Día JL, de la Cámara C, Ventura T, Morales-Asín F, Fernando-Pascual L, Montañés JA, Aznar S (1999) Revalidation and standardization of the cognition mini-exam (first Spanish version of the Mini-Mental Status Examination) in the general geriatric population. Med Clin 112:767–774

    CAS  Google Scholar 

  24. Ventura MA, Green MF, Shaner A et al (1993) Training and quality assurance with the Brief Psychiatric Rating Scale: “The drift buster”. Int J Meth Psych Res 3:221–244

    Google Scholar 

  25. Degner LF, Sloan JA, Venkatesh P (1997) The control preferences scale. Can J Nurs Res 29:21–43

    PubMed  CAS  Google Scholar 

  26. de las Cuevas C, Peñate W (2016) Validity of the control preferences scale in patients with emotional disorders. Patient Prefer Adher 10:2351–2356. https://doi.org/10.2147/PPA.S122377

    Article  Google Scholar 

  27. de las Cuevas C, Peñate W, de Rivera L (2014) To what extent is treatment adherence of psychiatric patients influenced by their participation in shared decision making? Patient Prefer Adher 8:1547–1553. https://doi.org/10.2147/PPA.S73029

    Article  Google Scholar 

  28. Ortega M, Cayuela A (2002) Regresión logística no condicionada y tamaño de muestra: una revisión bibliográfica. Rev Esp Salud Publica 76:85–93

    Article  Google Scholar 

  29. Perduzzi P, Concato J, Kemper E, Holford TR, Feinstein AR (1996) A simulation study of the number of events per variable in logistic regression analysis. J Clin Epidemiol 49:1373–1379

    Article  Google Scholar 

  30. Nuñez E, Steyerberg EW, Nuñez J (2011) Regression modeling strategies. Rev Esp Cardiol 64:501–507. https://doi.org/10.1016/j.recesp.2011.01.019

    Article  PubMed  Google Scholar 

  31. Ford S, Schofield T, Hope T (2003) Are patients’ decision-making preferences being met? Health Expect 6:72–80

    Article  Google Scholar 

  32. Murray E, Pollack L, White M, Lo B (2007) Clinical decision-making: patients’ preferences and experiences. BMC Fam Pract 65:189–196. https://doi.org/10.1186/1471-2296-8-10

    Article  Google Scholar 

  33. Stovell D, Morrison AP, Panayiotou M, Hutton P (2016) Shared treatment decision-making and empowerment-related outcomes in psychosis: systematic review and meta-analysis. Br J Psychiatr 209:23–28. https://doi.org/10.1192/bjp.bp.114.158931

    Article  Google Scholar 

  34. Comitè de Bioètica de Catalunya (2017) El respeto a la voluntad de la persona con trastorno mental y/o adicción: documento de voluntades anticipadas y planificación de decisiones anticipadas. https://www.researchgate.net/publication/323677344_El_respecte_a_la_voluntat_de_la_persona_amb_trastorn_mental_io_addiccio_document_de_voluntats_anticipades_i_planificacio_de_decisions_anticipades. Accessed 02 Feb 2019

  35. de las Cuevas C, Perestelo-Perez L, Rivero-Santana A, Cebolla-Martí A, Scholl I, Härter M (2014) Validation of the spanish version of the 9-item shared decision-making questionnaire. Health Expect 18:2143–2153. https://doi.org/10.1111/hex.12183

    Article  Google Scholar 

  36. Farrelly S, Brown G, Rose D, Doherty E, Claire Henderson R, Birchwood M, Marshall M, Waheed W, Szmukler G, Thornicroft G (2014) What service users with psychotic disorders want in a mental health crisis or relapse: thematic analysis of joint crisis plans. Soc Psychiatr Psychiatr Epidemiol 49:1609–1617. https://doi.org/10.1007/s00127-014-0869-1

    Article  Google Scholar 

  37. Hamann J, Cohen R, Leucht S, Busch R, Kissling W (2005) Do patients with schizophrenia wish to be involved in decisions about their medical treatment? Am J Psychiatr 162:2382–2384. https://doi.org/10.1176/appi.ajp.162.12.2382

    Article  PubMed  Google Scholar 

  38. Hamann J, Mendel R, Cohen R, Heres S, Ziegler M, Buhner M, Kissling W (2009) Psychiatrists’ Use of shared decision making in the treatment of schizophrenia: patient characteristics and decision topics. Psychiatr Serv 60:1107–1112. https://doi.org/10.1176/appi.ps.60.8.1107

    Article  PubMed  Google Scholar 

  39. Sweeney A, Gillard S, Wykes T, Rose D (2015) The role of fear in mental health service users’ experiences: a qualitative exploration. Soc Psychiatr Psychiatr Epidemiol 50:1079–1087. https://doi.org/10.1007/s00127-015-1028-z

    Article  Google Scholar 

  40. Wynn R (2018) Involuntary admission in Norwegian adult psychiatric hospitals: a systematic review. Int J Ment Health Syst 12:10. https://doi.org/10.1186/s13033-018-0189-z

    Article  PubMed  PubMed Central  Google Scholar 

  41. Kasilova L, Raboch J, Sampogna G, Cihal L, Kallert TW, Onchev G, Karastergiou A, del Vecchio V, Kiejna A, Admowski T, Torres-Gonzales F, Cervilla JA, Priebe S, Giacco D, Kjellin L, Dembinskas A, Fiorillo A (2014) Do patients and ward-related characteristics influence the use of coercive measures? Results from the EUNOMIA international study. Soc Psychiatr Psychiatr Epidemiol 49:1619–1629. https://doi.org/10.1007/s00127-014-0872-6

    Article  Google Scholar 

  42. Myklebust LH, Sørgaard K, Røtvold K, Wynn R (2012) Factors of importance to involuntary admission. Nord J Psychiatr 66:178–182. https://doi.org/10.3109/08039488.2011.611252

    Article  Google Scholar 

  43. Gabbard GO (1992) The therapeutic relationship in psychiatric hospital treatment. B Menninger Clin 56(1):4–19

    CAS  Google Scholar 

  44. Hill SA, Laugharne R (2006) Decision making and information seeking preferences among psychiatric patients. J Ment Health 15:75–84. https://doi.org/10.1080/09638230500512250

    Article  Google Scholar 

  45. Borry P, Schotsmans P, Dierickx K (2006) Evidence-based medicine and its role in ethical decision-making. J Eval Clin Pract 12:306–311. https://doi.org/10.1111/j.1365-2753.2006.00548.x

    Article  PubMed  Google Scholar 

  46. Brom L, Hopmans W, Pasman RW, Timmermans DR, Widdershoven GA, Onwuteaka-Philipsen BD (2014) Congruence between patients’ preferred and perceived participation in medical decision-making: a review of the literature. BMC Med Inform Decis Mak 14:1–16. https://doi.org/10.1186/1472-6947-14-25

    Article  Google Scholar 

  47. de las Cuevas C, Rivero-Santana A, Perestelo-Perez L, Pérez-Ramos J, Serrano-Aguilar P (2012) Attitudes toward concordance in psychiatry: a comparative, cross-sectional study of psychiatric patients and mental health professionals. BMC Psychiatr 12:1–7. https://doi.org/10.1186/1471-244X-12-53

    Article  Google Scholar 

  48. European Parliament and the Council of the European Union. Additional protocol to the convention on human rights and biomedicine concerning genetic testing for health purposes. 203. 2008. European Treaty Series. No. 203. https://rm.coe.int/1680084824. Accessed 01 May 2019

  49. United Nations. Committee on the rights of persons with disabilities. Eleventh Session. General comment No. 1. Article 12. (2014). Equal recognition before the law. https://www.un.org/development/desa/disabilities/convention-on-the-rights-of-persons-with-disabilities.html. Accessed 03 Feb 2019

Download references

Acknowledgements

We would like to thank everyone who participated in the study and Dr Ibañez-López and Dra Ruiz-Merino for their statistical advice.

Author information

Authors and Affiliations

  1. Mental Health Centre, Health Service of Murcia, CSM Cartagena, Calle Real, 8, 30201, Murcia, Spain

    Inés Morán-Sánchez & María A. Bernal-López

  2. Department of Legal and Forensic Medicine, Faculty of Medicine, Biomedical Research Institute (IMIB), Regional Campus of International Excellence “Campus Mare Nostrum”, University of Murcia, Murcia, Spain

    Maria D. Pérez-Cárceles

Authors
  1. Inés Morán-Sánchez
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. María A. Bernal-López
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria D. Pérez-Cárceles
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Inés Morán-Sánchez.

Ethics declarations

All authors declare that the submitted work has not been published before and that the work is not under consideration for publication elsewhere.

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical approval

This study has been approved by the ethics committee of our referral hospital and has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Spanish laws have been observed, too.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Morán-Sánchez, I., Bernal-López, M.A. & Pérez-Cárceles, M.D. Compulsory admissions and preferences in decision-making in patients with psychotic and bipolar disorders. Soc Psychiatry Psychiatr Epidemiol 55, 571–580 (2020). https://doi.org/10.1007/s00127-019-01809-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00127-019-01809-4

Keywords

Search

Navigation