University Psychiatric Clinics Basel, University of Basel, Basel, Switzerland.
Health Department of Basel-Stadt, Cantonal Medical Service, Social Medicine, Basel, Switzerland.
Int J Soc Psychiatry. 2023 Jun;69(4):865-874. doi: 10.1177/00207640221141020. Epub 2022 Dec 1.
According to federal and cantonal law, persons with an acute mental illness can be admitted to a psychiatric hospital or another suitable institution against their will, when other therapeutic options are not available or have been exhausted. In the canton of Basel-Stadt, this is the responsibility of public health officers employed by the division of of the cantonal Health Department.
This study aims to elucidate which factors influence the decision-making of public health officers regarding compulsory admissions over the period from September 2013 to April 2022 in the canton of Basel-Stadt.
Leveraging comprehensive clinical data from the health department of the canton Basel-Stadt ( = 5,'550), we estimated a mixed effects logistic regression model to identify factors contributing to the decision of public-health officers to compulsorily admit patients, while controlling for potential clustering effects among public health officers.
The risk for compulsory admissions was most strongly predicted by the presence of potential self-harm. In comparison, while being a strong predictor, potential harm to others played a considerably lesser role. Furthermore, psychiatric syndrome, previous compulsory admissions, and the specific context of evaluation were significant predictors. Finally, we found no meaningful personal bias among public health officers.
The results suggest that public health officers' decision-making regarding compulsory admissions focuses on preventing self-harm and, to a lesser degree, harm to others. This indicates that such measures are only used as a measure of last resort, which is in line with current evidence regarding the detrimental effects of compulsory measures on treatment outcomes in psychiatry. Our findings suggest that all relevant stakeholders, including the police, share this perspective. Decision-making regarding compulsory admissions was mostly free of personal biases, suggesting adherence to shared professional standards by public health officers.
根据联邦和州法律，当其他治疗选择不可用或已用尽时，患有急性精神疾病的人可以被强制送往精神病院或其他合适的机构，这是巴塞尔城市州公共卫生官员的职责。
本研究旨在阐明在 2013 年 9 月至 2022 年 4 月期间，巴塞尔城市州公共卫生官员在决定强制入院时影响其决策的因素。
利用巴塞尔城市州卫生部的综合临床数据（ = 5550），我们估计了一个混合效应逻辑回归模型，以确定公共卫生官员决定强制入院的因素，同时控制公共卫生官员之间的潜在聚类效应。
强制入院的风险最强预测因素是存在潜在的自我伤害。相比之下，虽然是一个强有力的预测因素，但对他人的潜在伤害作用要小得多。此外，精神科综合征、以前的强制入院和评估的具体情况也是显著的预测因素。最后，我们没有发现公共卫生官员之间存在有意义的个人偏见。
结果表明，公共卫生官员在决定强制入院时的决策重点是预防自我伤害，在较小程度上是预防对他人的伤害。这表明，这些措施仅作为最后的手段使用，这与关于强制措施对精神病学治疗结果的不利影响的当前证据一致。我们的发现表明，所有相关利益相关者，包括警察，都持这种观点。强制入院的决策基本上没有个人偏见，这表明公共卫生官员遵守了共同的专业标准。
