Admission without consent and use of means of physical coercion on the example of psychiatric hospital in Wrocław

Purpose: In Poland, the issue of hospitalising patients against their will and using means of direct physical coercion are regulated by the provisions of Law on Mental Health Protection (LoMHP); however, but no regular studies have been conducted to facilitate monitoring of the incidence of using coercive measures in the entire country. The aim of the study is to assess the incidence of using direct coercion measures on the patients admitted to in-patient wards of psychiatric hospitals and using such measures in Psychiatric Hospital in Wrocław, in the period from 2011 to 2015.

Methods: The monitoring questionnaires of LoMHP, data on admissions and basic data characterising compulsory treatment were used. In order to assess the quality of psychiatric treatment and psychosocial rehabilitation, the International Classification of Mental Health Care questionnaire was used.

Results: The average of involuntary admissions in the period between 2011 and 2015 amounted to 28.92%. The rates of admissions against the will of the patient based on articles 23, 24 and 29 of LoMHP, and the rate of patients held in hospital based on article 28 of LoMHP were stable in the studied period. The vast majority of involuntary admissions was based on article 23. The ratio of involuntary hospitalisation for 100 thousand residents was on average 65.14. Involuntary admissions usually referred to people with diagnosed F20 (schizophrenia) and F31 (bipolar disorders). Direct coercive measures were used on average on 19.64% hospitalised patients.

Conclusions: PThe use of coercion is a common phenomenon in psychiatric institutions in Poland. The ratio of involuntary hospitalisation for 100 thousand residents was within the average values of this ratio in other countries.