The relationship between area levels of involuntary psychiatric care and patient outcomes: a longitudinal national register study from Norway

BMC Psychiatry

Research

Tore Hofstad¹  Jorun Rugkåsa²  Olav Nyttingnes³  Jūratė Šaltytė Benth⁴ 

[1] Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway;Centre for Medical Ethics, University of Oslo, Oslo, Norway;Health Services Research Unit, Akershus University Hospital, Nordbyhagen, Norway;Centre for Care Research, University of South-Eastern Norway, Notodden, Norway;Health Services Research Unit, Akershus University Hospital, Nordbyhagen, Norway;Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway;Health Services Research Unit, Akershus University Hospital, Nordbyhagen, Norway;Institute of Clinical Medicine, University of Oslo, Oslo, Norway;

关键词: Involuntary care;    Coercion;    Compulsion;    Severe mental disorders;    Register study;    Mental health legislation;   

DOI  :  10.1186/s12888-023-04584-4

 received in 2022-09-20, accepted in 2023-02-02,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundMental health legislation permits involuntary care of patients with severe mental disorders who meet set legal criteria. The Norwegian Mental Health Act assumes this will improve health and reduce risk of deterioration and death. Professionals have warned against potentially adverse effects of recent initiatives to heighten involuntary care thresholds, but no studies have investigated whether high thresholds have adverse effects.AimTo test the hypothesis that areas with lower levels of involuntary care show higher levels of morbidity and mortality in their severe mental disorder populations over time compared to areas with higher levels. Data availability precluded analyses of the effect on health and safety of others.MethodsUsing national data, we calculated standardized (by age, sex, and urbanicity) involuntary care ratios across Community Mental Health Center areas in Norway. For patients diagnosed with severe mental disorders (ICD10 F20-31), we tested whether lower area ratios in 2015 was associated with 1) case fatality over four years, 2) an increase in inpatient days, and 3) time to first episode of involuntary care over the following two years. We also assessed 4) whether area ratios in 2015 predicted an increase in the number of patients diagnosed with F20-31 in the subsequent two years and whether 5) standardized involuntary care area ratios in 2014–2017 predicted an increase in the standardized suicide ratios in 2014–2018. Analyses were prespecified (ClinicalTrials.gov NCT04655287).ResultsWe found no adverse effects on patients’ health in areas with lower standardized involuntary care ratios. The standardization variables age, sex, and urbanicity explained 70.5% of the variance in raw rates of involuntary care.ConclusionsLower standardized involuntary care ratios are not associated with adverse effects for patients with severe mental disorders in Norway. This finding merits further research of the way involuntary care works.

【 授权许可】

CC BY   
© The Author(s) 2023

【 图 表 】

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