Compulsory admission to a Portuguese psychiatric hospital: retrospective study of 497 involuntary admissions

Background

The Mental Health Act, implemented in 1998, establishes the principles of the Portuguese mental health policy and governs the compulsory admission of persons suffering from mental disorders. We examined factors concerning the civil commitment of patients in a Portuguese psychiatric hospital, responsible for the admissions of a population of 1,202,000 inhabitants.

Methods

The case records of 497 from a total of 522 consecutive involuntary admissions to Júlio de Matos' Psychiatric Hospital between January 1, 2005 and December 31, 2006, were examined retrospectively to assess sociodemographic, clinical and judicial characteristics. After excluding 41 out of area admissions, 456 involuntary admissions of 412 patients were analyzed.

Results

Males accounted for 66% of the compulsory detentions, and the patient's age at the majority of admissions was between 35 and 44 years. The majority of admissions (56%) involved single persons, which were either unemployed (43%) or retired (30%). The majority of patients (63%) came from their home and were accompanied by the police (62%) and/or by their families (27%), due to aggressive or violent behavior (61%). In 14% of the cases there had been a suicide attempt, with men attempting suicide significantly more often than women. We found low levels of alcohol and drug abuse (19% and 14% respectively). The mean admission duration was 24 days, with patients being compulsorily detained for a mean of 12 days, and thereafter passing to voluntary treatment for another 12 days. Schizophrenia and psychosis not elsewhere specified constituted the most frequent diagnoses.

Conclusion

The results suggest a specific profile for the patient with high risk of psychiatric compulsory detention: a middle aged unmarried man, unemployed, with the diagnosis of schizophrenia without comorbid substance abuse, who is taken to hospital by the authorities due to aggressive or violent behavior, and needs treatment in hospital for about 3 weeks.