Study Analyzes Interventions to Reduce Compulsory Psychiatric Admissions Interview with:

rsz_1pasfoto_mark_de_jongMark de Jong, MD, Psychiatrist
Yulius Academy, Yulius Mental Health
Barendrecht, the Netherlands What is the background for this study? What are the main findings?

Response: Compulsory psychiatric admission, defined as admission against the will of the patient, has a strong effect on psychiatric patients and their relatives, and can be traumatic. Compulsory admission also conflicts with human rights, principles of autonomy, shared decision making, and recovery focused care. We also see, that rates of compulsory admissions in several European countries are tending to rise. So, interventions that prevent patients from being compulsory admitted are urgently needed.

We reviewed and meta-analyzed all currently available RCTs, that were designed to reduce compulsory admission rates in adult psychiatric patients with severe mental illnesses in outpatients settings. We found, that advance statements, like crisis plans, showed a significant 23% risk reduction in compulsory admissions. In contrast, community treatment orders and interventions for compliance enhancement showed no significant risk reduction in compulsory admissions. Although RCTs on integrated treatment showed no statistically significant risk reduction, we found a potentially clinically relevant risk reduction of 29%. What should readers take away from your report?

Response: Our findings emphasize the importance of advance statements, like crisis plans. We showed, that these kind of interventions are effective to reduce the risk of being compulsorily admitted and we consider the figure of 23% risk reduction in compulsory admissions as clinically relevant. This result also highlights the fact that, by advocating patients’ desires and preferences regarding a future crisis and by involving family and friends, advance treatment planning is an important and helpful process for psychiatric patients. What recommendations do you have for future research as a result of this study?

Response: Advance statements and integrated treatment, interventions that target the health care process as a whole, are probably more effective than community treatment orders and compliance enhancement, which target one specific element of the health care process. This should encourage us to invest in research that combines several specific interventions and thereby provides the most vulnerable patients with integrated treatment. Possibly, if only one RCT could be added to the meta-analysis of the RCTs on integrated treatment, the risk reduction would become statistically significant. Is there anything else you would like to add?

Response: We found only 13 RCTs in which intent to reduce compulsory admissions was the first or secondary outcome measure. In light of human rights and the effect compulsory admissions have on psychiatric patients and their relatives, this number is both small and disappointing. This demonstrates the urgent need for more research in this field, for the benefit of psychiatric patients with severe mental illnesses and their relatives. Thank you for your contribution to the community.


de Jong MH, Kamperman AM, Oorschot M, et al. Interventions to Reduce Compulsory Psychiatric Admissions: A Systematic Review and Meta-analysis. JAMA Psychiatry.Published online June 01, 2016. doi:10.1001/jamapsychiatry.2016.0501.

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.

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Last Updated on June 2, 2016 by Marie Benz MD FAAD