Hostname: page-component-586b7cd67f-t7czq Total loading time: 0 Render date: 2024-11-25T10:16:58.698Z Has data issue: false hasContentIssue false
  • English
  • Français

Differences in the use of involuntary admission across the Veneto Region: which role for individual and contextual variables?

Published online by Cambridge University Press:  09 December 2014

V. Donisi ,
F. Tedeschi ,
D. Salazzari  and
F. Amaddeo
V. Donisi*
Affiliation:
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, 37134 Verona, Italy
F. Tedeschi
Affiliation:
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, 37134 Verona, Italy
D. Salazzari
Affiliation:
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, 37134 Verona, Italy
F. Amaddeo
Affiliation:
Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, 37134 Verona, Italy
*
*Address for correspondence: V. Donisi, Section of Psychiatry, Department of Public Health and Community Medicine, University of Verona, Policlinico G.B. Rossi, Piazzale L.A. Scuro 10, 37134 Verona, Italy. (Email: [email protected])
Get access Rights & Permissions [Opens in a new window]

Abstract

Aims.

The first aim of this study is to compare involuntary admissions across the Veneto Region in Italy. The second aim is to explore the relation between mental health services provision, characteristics of population, individual factors and involuntary admissions.

Methods.

For 21 Mental Health Departments (MHDs) in the Veneto Region (Italy), the average population prevalence rate of involuntary admissions between 2000 and 2007 and the percentage of involuntary admissions were calculated. Chi-square tests for equality of proportions were used to test hypotheses. Variables at the individual, contextual and organisational levels were used in multiple regressions, with the involuntary admission data as dependent variables.

Results.

The average prevalence rate of involuntary commitment was 12.75 ranging from 1.96 to 27.59 across MHDs . About 75% of the involuntary admissions referred to psychotic patients, and almost half of patients were aged 25–44. Significant differences among MHDs emerged; higher percentages of involuntary admissions were generally found in densely populated areas. Higher ageing indices and rates of social workers were found as predictors of the prevalence rate. In the multilevel regression, being males and psychotic significantly increased involuntary admissions, while the percentage of singles in population decreased it.

Conclusions.

This study contributes to define the specific contribution of each factor predicting the use of involuntary admission, even within areas under the same legislation. It shows how the inclusion of both individual and contextual factors may lead to better predictions and provides precious data for the services improvement.

Keywords

Compulsory admissioninvoluntary admissionmultilevel logistic regressionpsychiatric hospital discharge
Type
Original Articles
Information
Epidemiology and Psychiatric Sciences , Volume 25 , Issue 1 , February 2016 , pp. 49 - 57
Copyright
Copyright © Cambridge University Press 2014 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Amaddeo, F, Barbui, C, Tansella, M (2012). State of psychiatry in Italy 35 years after psychiatric reform. A critical appraisal of national and local data. International review of psychiatry 24, 314–320.Google Scholar
Angermeye, MC, H, Matschinger, H, Schomerus, G (2014). Attitudes of the German public to restrictions on persons with mental illness in 1993 and 2011. Epidemiology and Psychiatric Sciences 23, 263–270.Google Scholar
Bindman, J, Tighe, J, Thornicroft, G, Leese, M (2002). Poverty, poor services, and compulsory psychiatric admission in England. Social Psychiatry and Psychiatric Epidemiology 37, 341–345.Google Scholar
Bowers, L, Van Der Merwe, M, Paterson, B and Stewart, D (2012). Manual restraint and shows of force: The City-128 study. International Journal of Mental Health Nursing 21, 30–40.Google Scholar
Busse, R, Geissler, A, Quentin, W, Wiley, M (2011). Diagnosis-Related Groups in Europe. Moving Towards Transparency, Efficiency and Quality in Hospitals. McGraw-Hill: England.Google Scholar
Canadian Federal/Provincial/Territorial Advisory Network on Mental Health. (2001). Accountability and Performance Indicators for Mental Health Services and Supports. Health Canada: Ontario.Google Scholar
de Girolamo, G, Barbato, A, Bracco, R, Gaddini, A, Miglio, R, Morosini, P, Norcio, B, Picardi, A, Rossi, E, Rucci, P, Santone, G, Dell'Acqua, G, PROGRES-Acute Group (2007). Characteristics and activities of acute psychiatric in-patient facilities: National survey in Italy. British Journal of Psychiatry 191, 170–177.Google Scholar
Emons, B, Haussleiter, IS, Kalthoff, J, Schramm, A, Hoffmann, K, Jendreyschak, J, Schaub, M, Armgart, C, Juckel, G, Illes, F (2013). Impact of social-psychiatric services and psychiatric clinics on involuntary admissions. International Journal of social Psychiatry 2013 Dec 12. [Epub ahead of print]Google Scholar
Eurostat Labour Market Working Group. (2011). The New Degree of Urbanisation: Methodology. Available at http://ec.europa.eu/eurostat/ramon/miscellaneous/index.cfm?TargetUrl=DSP_DEGURBA. Accessed 29 May 2014 Google Scholar
Fiorillo, A, De Rosa, C, Del Vecchio, V, Jurjanz, L, Schnall, K, Onchev, G, Alexiev, S, Raboch, J, Kalisova, L, Mastrogianni, A, Georgiadou, E, Solomon, Z, Dembinskas, A, Raskauskas, V, Nawka, P, Nawka, A, Kiejna, A, Hadrys, T, Torres-Gonzales, F, Mayoral, F, Björkdahl, A, Kjellin, L, Priebe, S, Maj, M, Kallert, T (2011). How to improve clinical practice on involuntary hospital admissions of psychiatric patients: suggestions from the EUNOMIA study. Euopean Psychiatry 26, 201–207.Google Scholar
Guaiana, G, Barbui, C (2004). Trends in the use of the Italian Mental Health Act, 1979–1997. European Psychiatry 19, 444–445.Google Scholar
Hustoft, K, Larsen, TK, Auestad, B, Joa, I, Johannessen, JO, Ruud, T (2013). Predictors of involuntary hospitalisations to acute psychiatry. International Journal of Law and Psychiatry 36, 136–143.Google Scholar
Husum, TL, Bjørngaard, JH, Finset, A, Ruud, T (2010). A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics. BMC Health Services Research 10, 89.Google Scholar
Huxley, P, Kerfoot, M (1993). Variation in requests to social services departments for assessment for compulsory psychiatric admission. Social Psychiatry and Psychiatric Epidemiology 28, 71–76.Google Scholar
ISTAT. (2007). Popolazione residente per età, sesso e stato civile al 1° gennaio 2007. Istituto Poligrafico e Zecca dello Stato: Roma. Available at http://demo.istat.it/pop2007/index.html. Accessed 29 May 2014 Google Scholar
Kallert, TW, Glöckner, M, Schützwohl, M (2008). Involuntary vs. voluntary hospital admission. A systematic literature review on outcome diversity. European Archives of Psychiatry and Clinical Neuroscience 258, 195–209.Google Scholar
Keown, P, Weich, S, Bhui, KS, Scott, J (2011). Association between provision of mental illness beds and rate of involuntary admissions in the NHS in England 1988–2008: ecological study. BMJ 343, d3736.Google Scholar
Lay, B, Nordt, C, Rossler, W (2011). Variation in use of coercive measures in psychiatric hospitals. European Psychiatry 26, 244–251.Google Scholar
Lay, B, Salize, HJ, Dressing, H, Rüsch, N, Schönenberger, T, Bühlmann, M, Bleiker, M, Lengler, S, Korinth, L, Rössler, W (2012). Preventing compulsory admission to psychiatric inpatient care through psycho-education and crisis focused monitoring. BioMed Central Psychiatry 12, 136.Google Scholar
Luciano, M, Sampogna, G, Del Vecchio, V, Pingani, L, Palumbo, C, De Rosa, C, Catapano, F, Fiorillo, A (2014). Use of coercive measures in mental health practice and its impact on outcome: a critical review. Expert review of neurotherapeutics 14, 131–141.Google Scholar
Myklebust, LH, Sørgaard, K, Wynn, R (2014). Local psychiatric beds appear to decrease the use of involuntary admission: a case-registry study. BioMed Central Health Services Research 14, 64.Google Scholar
Salize, HJ, Dressing, H (2004). Epidemiology of involuntary placement of mentally ill people across the European Union. British Journal of Psychiatry 184, 163–168.Google Scholar
Salize, HJ, Dressing, H, Peitz, M (2002). Compulsory Admission and Involuntary Treatment of Mentally Ill Patients – Legislation and Practice in EU-Member States. Final Report of the Research Project - Grant Agreement No. SI2.254882 (2000CVF3-407). European Commission, Germany.Google Scholar
Pertile, R, Donisi, V, Grigoletti, L, Angelozzi, A, Zamengo, G, Zulian, G, Amaddeo, F (2011). DRGs and other patient-, service- and area-level factors influencing length of stay in acute psychiatric wards: the Veneto Region experience. Social Psychiatry and Psychiatric Epidemiology 46, 651–660.Google Scholar
Priebe, S, Badesconyi, A, Fioritti, A, Hansson, L, Kilian, R, Torres-Gonzales, F, Turner, T, Wiersma, D (2005). Reinstitutionalisation in mental health care: comparison of data on service provision from six European countries. BMJ 330, 123–126.Google Scholar
R Development Core Team (2011). R 2.13.0. R: A Language and Environment for Statistical Computing. R Foundation for Statistical Computing: Austria.Google Scholar
Regione Veneto (2010). La tutela della Salute Mentale nel Veneto. Rapporto 2010. Regione Veneto: Venezia.Google Scholar
StataCorp (2013). Stata Statistical Software: Release 13. College Station, StataCorp LP: TX.Google Scholar
Tarsitani, L, Pasquini, M, Maraone, A, Zerella, MP, Berardelli, I, Giordani, R, Polselli, GM, Biondi, M (2012). Acute psychiatric treatment and the use of physical restraint in first-generation immigrants in Italy: a prospective concurrent study. International Journal of Social Psychiatry 59, 613–618.Google Scholar
Webber, M, Huxley, P (2004). Social exclusion and risk of emergency compulsory admission. A case-control study. Social Psychiatry and Psychiatric Epidemiology 39, 1000–1009.Google Scholar
Wierdsma, AI, Mulder, CL (2009). Does mental health service integration affect compulsory admissions? International Journal of Integrated Care 9, e90.Google Scholar
World Health Organisation (1992). The ICD-10 Classification of Mental and Behavioural Disorders: Clinical Description and Diagnostic Guidelines. WHO: Geneve.Google Scholar
Zinkler, M, Priebe, S (2002). Detention of the mentally ill in Europe – a review. Acta Psychiatrica Scandinavica 106, 3–8.Google Scholar