Ma Hua-Jian, Zheng Yu-Chen, Xie Bin, Shao Yang
Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, 600 Wan Ping Nan Road, Shanghai, P. R. China.
Int J Soc Psychiatry. 2022 Jun;68(4):745-753. doi: 10.1177/00207640211007154. Epub 2021 Apr 16.
The 'risk criterion' for involuntary admission (IA) has been adopted by Mental Health Law of the People's Republic of China since 2013. How the new legal regulation influences daily practices in psychiatric institutes are still unclear.
The present study sought to explore the application of risk criterion in IA cases; especially risk assessed by psychiatrists at admission and its influencing factors.
Socio-demographic and clinical data including risk assessment for admission of 3,529 involuntary admitted patients from two typical hospitals in Shanghai from 2013 to 2014 were consecutively collected. Personal information of psychiatrists who made admission assessment was collected separately.
Among the 3,529 cases, 1,890 (53.6%) were admitted because of actual harmful behaviors to self or others, while 1,639 (46.4%) were admitted with some kinds of risk, but 265 (7.5%) were admitted without any records on risk assessment checklists. Patients who were unemployed, of younger age, single status, diagnosed with schizophrenia were more likely to be admitted without any records on the checklist. Male gender, older age, and lower professional title are influencing factors that psychiatrists made no risk assessment records.
The vast majority (92.5%) of risk assessment in IA patients were qualified in our study. In order to protect the legal rights of patients better, operational and reasonable procedures of risk assessment should be developed, such include more detailed rules to IA, systematic training of psychiatrists on IA assessment, mechanism improving doctor-patient relationship, and alternative mental health services for patients and so on.
自2013年起，《中华人民共和国精神卫生法》采用了非自愿住院治疗（IA）的“风险标准”。这项新的法律法规如何影响精神病院的日常实践仍不明确。
本研究旨在探讨风险标准在非自愿住院治疗病例中的应用；尤其是精神科医生在入院时进行的风险评估及其影响因素。
连续收集2013年至2014年来自上海两家典型医院的3529例非自愿住院患者的社会人口学和临床数据，包括入院风险评估。分别收集进行入院评估的精神科医生的个人信息。
在3529例病例中，1890例（53.6%）因对自己或他人有实际伤害行为而入院，而1639例（46.4%）因存在某种风险而入院，但265例（7.5%）入院时风险评估清单上没有任何记录。失业、年龄较小、单身、被诊断为精神分裂症的患者更有可能在清单上没有任何记录的情况下入院。男性、年龄较大和职称较低是精神科医生没有进行风险评估记录的影响因素。
在我们的研究中，非自愿住院治疗患者中绝大多数（92.5%）的风险评估是合格的。为了更好地保护患者的合法权益，应制定操作性强且合理的风险评估程序；比如，制定更详细的非自愿住院治疗规则，对精神科医生进行非自愿住院治疗评估的系统培训，改善医患关系的机制，以及为患者提供替代性精神卫生服务等。
