Comparison of involuntary hospitalization rates

Background

Civil commitment rates show substantial variation between different countries and over time. Legislation, professionals' ethics and attitudes, socio-demographic variation, and psychiatric services have been suggested as reasons for this. International variations in procedures and registration of coercion might affect reliability and validity of the data used, complicating international comparison. Objective: To discuss reasons for international variation of commitment rates, to expose periods of deprivation of liberty introduced during psychiatric admissions, classified formally as voluntary or involuntary, and to evaluate the impact of these results on the public statistics of commitment rates in the Nordic countries.

Methods

6,048 admissions, 1,841 involuntary, 4,207 voluntary, to psychiatric wards in the Nordic countries were, based on information in the medical files, evaluated by a uniform registration form of introduced deprivation of liberty during referral, admission and stay.

Results

Almost all involuntary admissions in Denmark, Finland and Norway were preceded by an involuntary referral; in Iceland and Sweden it was 94.6% and 88.9%. In Denmark, Iceland and Sweden 0.1% – 0.7% of the voluntary admissions were preceded by an involuntarily referral, while it was 3.3% and 11.4% in Finland and Norway. Denmark and Norway had the highest proportion of patients who were subjected to deprivation of liberty in spite of being voluntarily admitted, 20.8% and 11.6%, compared to 3.6% – 9.8% in the other countries.

Conclusion

Commitment rates based on the formal classification of commitment in the Nordic countries are not directly comparable due to differing registration of deprivation of liberty introduced during referral, admission and stay. Deprivation of liberty introduced during psychiatric admissions formally classified as voluntary exists to a varying degree in the Nordic countries, resulting in a varying underestimation of coercion used.