Use of a proforma to aid in reducing coercion into informal admission for acute adult psychiatric inpatients in the U.K

Leg Med (Tokyo). 2019 Feb;36:103-109. doi: 10.1016/j.legalmed.2018.11.011. Epub 2018 Nov 23.


Background: People with acute psychiatric illness may be at risk of coercion into informal admission. A lack of capacity assessment (CA) and provision of adequate information (PAI) for informal patients may constitute a risk of coercive admitting practice, resulting in increased use of the mental health act (MHA) in the days following admission. We developed and tested a proforma to aid in ensuring CA and PAI for informal admissions.

Method: A pilot case-study was conducted in 2015 at a U.K. NHS trust (n = 50), analysing the prevalence of CA & PAI for adult psychiatric inpatient admissions, alongside the prevalence of MHA use in the next 72 h. Case-note audits were completed in 2016 & 2017 (n = 100 each), to assess the impact of the proforma in improving documented CA & PAI, alongside the prevalence of MHA use in the next 72 h. We tested for any demographic associations with CA & PAI using logistic regression.

Results: CA improved from 39% (2015) to 60% (2017). PAI improved from 9% (2015) to 45% (2017). Use of the MHA in the 72 h following admission fell from 32% (2015) to 7% (2017). Most informal admissions detained within 72 h had no record of CA & PAI. People under the age of 26 years were significantly less likely to have documented CA & PAI.

Implications: Use of the proforma was successful in improving CA & PAI in a U.K.

Population: Further improvements could be made. Future research should seek to further examine demographic differences in informal coercion.

Keywords: Capacity; Coercion; Informed consent; Mental health act; Psychiatry.

MeSH terms

  • Acute Disease
  • Adult
  • Coercion*
  • Female
  • Humans
  • Informed Consent*
  • Inpatients*
  • Logistic Models
  • Male
  • Mental Disorders*
  • Mental Health / legislation & jurisprudence
  • Middle Aged
  • Patient Admission / statistics & numerical data*
  • Pilot Projects
  • Risk
  • Surveys and Questionnaires
  • Time Factors
  • United Kingdom / epidemiology