Involuntary psychiatric holds - the structure of admissions on the example of Institute of Psychiatry and Neurology in Warsaw.

OBJECTIVES: The aim of the study was to analyse the structure of involuntary psychiatric holds in Institute of Psychiatry and Neurology in Warsaw, throughout the year. Our research interests included socio-demographic profiles of the patients, time of admissions (time of a day/night/ season), type of diagnoses at admission and suicide attempts preceding the admission. We also analysed the normative aspect of involuntary admissions, i.e. which Articles of the Polish Mental Health Act constituted the basis for these patients admission, and if the choice of articles was justifiable by a diagnosis of the mental disorder.

METHODS: The primary research tool consisted of an original questionnaire allowing for the collection of relevant data. The material was submitted to statistical analysis, using primarily simple percentage methods.

RESULTS: Involuntary psychiatric holds constituted 15.8% of the total number of admissions to the Institute of Psychiatry and Neurology (3,498 persons) in 2012. 522 persons with mental disorders were subject to involuntary admission on emergency basis (292 women and 260 men). Majority of patients was over 40 years old. The number of patients admitted to the Institute of Psychiatry and Neurology on emergency basis without the consent ranged from 38 to 62 people per month. Season did not differentiate significantly the number of admitted persons, majority of patients was admitted during the day (82%). Among the diagnosed patients, paranoid schizophrenia was the most frequent illness (43%), delirium tremens (7%), bipolar disorders (6%), dementia (5%), other psychotic disorders (5%), paranoid syndrome (5%), schizoaffective disorder (5%), other diagnoses (less than 1%). 4% of admissions to the Institute of Psychiatry and Neurology were due to attempted suicide. 37% of patients were admitted to the Institute of Psychiatry and Neurology under Article 23.1 of the Mental Health Act, 34% under Article 22.2, in accordance with Article 24.1 - only 7% of patients. Invoking Article 28 of the Mental Health Act by doctors referred to 14% of patients admitted without consent.

CONCLUSIONS: Involuntary psychiatric admissions are common practice not only in Poland but in the world. The structure of involuntary admissions in the Institute of Psychiatry and Neurology in 2012 did not differ from data from other European countries. However, while quantitative measures describing the phenomenon of involuntary admissions are comparable, knowledge of each country's legal rules in relation to medical conditions is crucial for truly adequate comparisons. From the point of view of the Polish legal system it is essential for doctors, who decide on the admission of the patient against his will, to adequately evaluate the patient's condition in relation to statutory requirements that point to the need of such an admission. Involuntary hospitalisation and treatment first and foremost serve the welfare and protection of chief values of life and human health.