Symptoms, dangerousness and involuntary admission

Background

The number of involuntary admissions in the Netherlands increased from 40 per 100,000 citizens in 1997 to 48 in 2005. During this period the mental health law did not change. In the Netherlands patients can be involuntarily admitted if they have a mental disorder causing dangerous behavior. One of the reasons for the increase in commitments may be that there is a shift in dangerousness criteria medical doctors apply when ordering an emergency involuntary admission.

Method

We used a national database on all emergency involuntary admission in the Netherlands in the period 1997 – 2005, containing information about demographics, diagnoses and dangerousness criteria.

Results

During the period 1997 – 2005 the percentage of patients having a psychotic disorder was approximately 53%. During this period, the frequency of using 'hard' criteria including 'suicide risk' and 'violence to others' did not change, whereas the use of other, 'soft' criteria including 'arousing aggression', 'severe self neglect' and 'severe social breakdown' as reasons for commitment increased significantly, from 41% to 54%, 36% to 45%, and 27% to 42%, respectively.

Conclusion

There has been a shift in dangerousness criteria from 'hard' to 'soft', applied to psychotic patients as reasons for emergency involuntary admissions in the Netherlands, possibly leading to more commitments.