Involuntary Treatment in Europe: Different Practices
Involuntary Treatment in Europe: Different Practices
Purpose of review Involuntary treatment is burdened by the lack of evidence. One of the challenges is the difference in practice across borders in Europe. While reviewing the current literature, a proposal of monitoring guidelines is discussed.
Recent findings The field is characterized by a small number of dedicated researchers. A study of violence in first-episode psychosis shows that differences in criteria for involuntary admission lead to different prognosis for the patients. The most recent contributions from the cross-national EUNOMIA study point to great variation across countries, regarding frequencies of involuntary admission as well as outcome. The EUNOMIA study provides suggestions for good quality in involuntary admission. A Cochrane review has examined the evidence of involuntary community treatment compared with standard treatment. The effectiveness of involuntary community treatment is limited. The review concludes that the benefits for a small number of patients are outweighed by the high numbers needed to treat in terms of avoided re-admission.
Summary Despite pioneering work, involuntary treatment is still caught up in tradition. There is a lack of standard and proof of effectiveness. A proposal of monitoring guidelines for involuntary measures is a first step to improve the situation.
Involuntary treatment and other involuntary measures in a medical context are almost exclusively used in the general psychiatric wards. Many of these measures are based on tradition rather than evidence. Involuntary treatment denotes medical treatment given without informed consent from the patient. A combination of certain criteria has to be present: 'Severe mental disorder' or 'psychotic disease' as well as 'dangerousness to self or others' – or 'need for treatment'. The treatment usually takes place in a hospital setting, but it may also be on an outpatient basis. The judicial surveillance is undertaken by a court or committee, and an appeal opportunity is required. Other physical or mechanical restraining measures like holding, seclusion rooms, netbeds, belts and cuffs may also be used during the course of treatment, and still other criteria have to be met. Intensive observation and forced medication are considered a part of the involuntary measures in some countries. It is evident that the number of permutations is infinite. In the following, however, involuntary treatment refers not only to medical treatment without consent, but also to the nonconsented subsidiary aspects and measures.
The purpose of this article is to review the current literature on involuntary treatment. Furthermore, I discuss how we can overcome some of the complexity of the issue and facilitate the way to improvement.
Abstract and Introduction
Abstract
Purpose of review Involuntary treatment is burdened by the lack of evidence. One of the challenges is the difference in practice across borders in Europe. While reviewing the current literature, a proposal of monitoring guidelines is discussed.
Recent findings The field is characterized by a small number of dedicated researchers. A study of violence in first-episode psychosis shows that differences in criteria for involuntary admission lead to different prognosis for the patients. The most recent contributions from the cross-national EUNOMIA study point to great variation across countries, regarding frequencies of involuntary admission as well as outcome. The EUNOMIA study provides suggestions for good quality in involuntary admission. A Cochrane review has examined the evidence of involuntary community treatment compared with standard treatment. The effectiveness of involuntary community treatment is limited. The review concludes that the benefits for a small number of patients are outweighed by the high numbers needed to treat in terms of avoided re-admission.
Summary Despite pioneering work, involuntary treatment is still caught up in tradition. There is a lack of standard and proof of effectiveness. A proposal of monitoring guidelines for involuntary measures is a first step to improve the situation.
Introduction
Involuntary treatment and other involuntary measures in a medical context are almost exclusively used in the general psychiatric wards. Many of these measures are based on tradition rather than evidence. Involuntary treatment denotes medical treatment given without informed consent from the patient. A combination of certain criteria has to be present: 'Severe mental disorder' or 'psychotic disease' as well as 'dangerousness to self or others' – or 'need for treatment'. The treatment usually takes place in a hospital setting, but it may also be on an outpatient basis. The judicial surveillance is undertaken by a court or committee, and an appeal opportunity is required. Other physical or mechanical restraining measures like holding, seclusion rooms, netbeds, belts and cuffs may also be used during the course of treatment, and still other criteria have to be met. Intensive observation and forced medication are considered a part of the involuntary measures in some countries. It is evident that the number of permutations is infinite. In the following, however, involuntary treatment refers not only to medical treatment without consent, but also to the nonconsented subsidiary aspects and measures.
The purpose of this article is to review the current literature on involuntary treatment. Furthermore, I discuss how we can overcome some of the complexity of the issue and facilitate the way to improvement.
