Arnold Benjamin D, Moeller Julian, Hochstrasser Lisa, Schneeberger Andres R, Borgwardt Stefan, Lang Undine E, Huber Christian G
Klinik für Erwachsene, Universitäre Psychiatrische Kliniken Basel (UPK), Universität Basel, Basel, Switzerland.
Department of Psychology, Division of Clinical Psychology and Epidemiology, University of Basel, Basel, Switzerland.
Front Psychiatry. 2019 Aug 9;10:544. doi: 10.3389/fpsyt.2019.00544. eCollection 2019.
When persons with a mental illness present a danger to themselves or others, involuntary hospital admission can be used to initiate an immediate inpatient treatment. Often, the patients have the right to appeal against compulsory admission. These processes are implemented in most mental health-care systems, but regulations and legal framework differ widely. In the Swiss canton of Basel-Stadt, a new regulation was implemented in January 2013. While the current literature holds some evidence for factors associated with involuntary admission, knowledge on who uses the right to appeal against admission is sparse. The study aims to examine if specific sociodemographic and clinical characteristics are associated with involuntary admission and with an appeal against the compulsory admission order. Routine clinical data of all inpatient cases admitted during the period from January 2013 to December 2015 at the Psychiatric University Hospital Basel were extracted. Generalized estimating equation (GEE) analyses were used to examine the association of sociodemographic and clinical characteristics with "involuntary admission" and "appeal against compulsory admission order." Of the 8,917 cases included in the present study, 942 (10.6%) were admitted involuntarily. Of these, 250 (26.5%) lodged an appeal against the compulsory admission order. Compared with cases admitted on a voluntary legal status, cases admitted involuntarily were older and were admitted more often during the nighttime or weekend. Moreover, involuntarily admitted cases had more often a principal diagnosis of a schizophrenia spectrum disorder. Patients from cases where an appeal was lodged were more often female, had more often Swiss nationality, and were more often diagnosed with schizophrenia spectrum disorder. Despite legal changes, the frequency of involuntary admissions in the observed catchment area seems to be relatively stable across the last 20 years. The percentage of appeals has decreased from 2000 to 2015, and only comparably few patients make use of the possibility to appeal. Better knowledge of the regulations, higher social functioning, and lower insight into illness might be associated with a higher probability of lodging an appeal. Future research should examine if specific patient groups are in need of additional assistance to exert their rights to appeal.
当患有精神疾病的人对自己或他人构成危险时，可以采用非自愿住院的方式启动即时住院治疗。通常，患者有权对强制住院提出上诉。大多数精神卫生保健系统都实施了这些程序，但相关规定和法律框架差异很大。在瑞士巴塞尔市，一项新规定于2013年1月开始实施。虽然目前的文献中有一些关于与非自愿住院相关因素的证据，但对于谁会行使对住院提出上诉的权利，了解却很少。 该研究旨在探讨特定的社会人口统计学和临床特征是否与非自愿住院以及对强制住院令的上诉有关。提取了2013年1月至2015年12月期间在巴塞尔大学精神病医院住院的所有病例的常规临床数据。采用广义估计方程（GEE）分析来研究社会人口统计学和临床特征与“非自愿住院”和“对强制住院令的上诉”之间的关联。在本研究纳入的8917例病例中，942例（10.6%）为非自愿住院。其中，250例（26.5%）对强制住院令提出了上诉。与自愿法律身份住院的病例相比，非自愿住院的病例年龄更大，夜间或周末住院更为频繁。此外，非自愿住院的病例更常以精神分裂症谱系障碍作为主要诊断。提出上诉的病例中的患者女性更多，瑞士国籍更多，且更常被诊断为精神分裂症谱系障碍。 尽管法律发生了变化，但在过去20年中，观察到的集水区内非自愿住院的频率似乎相对稳定。上诉的比例从2000年到2015年有所下降，只有相对较少的患者利用上诉的可能性。对规定有更好的了解、更高的社会功能以及对疾病的较低洞察力可能与提出上诉的可能性更高有关。未来的研究应探讨是否特定患者群体需要额外的帮助来行使他们的上诉权利。
