Involuntary admission of psychiatric patients: Referring physicians' perceptions of competence

Int J Soc Psychiatry. 2019 Nov;65(7-8):580-588. doi: 10.1177/0020764019866226. Epub 2019 Aug 4.


Background: Involuntary admissions can be detrimental for patients. Due to legal, ethical and clinical considerations, they are also challenging for referring physicians. Nevertheless, not much is known about the subjective perceptions of those who have to decide whether to conduct an involuntary admission or not.

Aims: This study aimed at answering the question whether psychiatrists' perceptions of confidence during psychiatric emergency situations and consecutive involuntary admissions differ from those of physicians without a psychiatric training.

Method: We assessed the professional background and subjective perceptions during psychiatric emergency situations in physicians who executed involuntary admissions to the University Hospital of Psychiatry Zurich. We used one-way analysis of variance (ANOVA) with Bonferroni-adjusted post hoc tests and chi-square tests to compare the responses of 43 psychiatrists with those of 64 other physicians.

Results: Psychiatrists felt less time constraints compared with non-psychiatric residents. The latter also had more doubts on the necessity of the involuntary admission issued. Psychiatrists considered themselves significantly more experienced in handling psychiatric emergency situations and in handling the criteria for involuntary admissions than other physicians. Psychiatrists and other physicians did not differ in their satisfaction concerning course and results of psychiatric emergency situations which was overall high. About half of all participants felt pressure from third parties.

Conclusion: Psychiatric emergency situations are challenging situations not only for patients but also for the involved physicians. Physicians with a specialized training might be more confident in the handling of psychiatric emergency situations and exertion of involuntary admissions. Non-psychiatric physicians might benefit from specialized training programs.

Keywords: Involuntary admission; coercion; decision-making; psychiatric emergency situation; referring physician.

MeSH terms

  • Adult
  • Emergency Services, Psychiatric / legislation & jurisprudence
  • Female
  • Humans
  • Involuntary Commitment / legislation & jurisprudence*
  • Male
  • Mental Disorders / diagnosis
  • Mental Disorders / therapy*
  • Middle Aged
  • Physicians*
  • Psychiatry / legislation & jurisprudence
  • Referral and Consultation / legislation & jurisprudence*
  • Switzerland