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How can variations in civil commitment rates within and between countries be understood?

Background

To compare civil commitment rates between different catchment areas in the Nordic countries and to explore how variations in civil commitment rates can be understood.

Methods

One psychiatric setting in Denmark, three in Finland, one in Iceland, four in Norway and three in Sweden participated in this part of the Nordic study on the use of coercion in the mental health care system. Data from medical records and related documents were registered for about 5,500 admissions of committed and voluntarily admitted patients in the years 1996–1999. A registration form specially designed for the study was used, including demographical and medical data and data on legal status for each admission. Information about the structure of the participating wards was collected separately.

Results

Nearly a tenfold difference was found between the catchment area with the highest and the area with the lowest civil commitment rate. Within countries, the greatest area variation was found between the three Swedish centers, with a threefold difference. The same magnitude of variation was found with regard to quotas of involuntary admissions, i.e. the proportion of civil commitments of all admissions. In preliminary analyses, no clear associations were found between civil commitment rates and demographic and clinical characteristics of the patients and organizational characteristics of the participating psychiatric wards.

Conclusion

Differences in legal prerequisites may be one factor explaining international variation in commitment rates, but predictors for variations within jurisdictions, with a uniform legislation, need to be further examined. The results of forthcoming analyses of the Nordic data will be presented.

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Correspondence to Lars Kjellin.

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Open Access This article is published under license to BioMed Central Ltd. This is an Open Access article is distributed under the terms of the Creative Commons Attribution 2.0 International License (https://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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Kjellin, L., Engberg, M., Høyer, G. et al. How can variations in civil commitment rates within and between countries be understood?. BMC Psychiatry 7, S142 (2007). https://doi.org/10.1186/1471-244X-7-S1-S142

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Keywords

  • Catchment Area
  • Mental Health Care
  • International Variation
  • Nordic Country
  • Area Variation