Changing patterns in emergency involuntary admissions in the Netherlands in the period 2000–2004

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Abstract

Background

In England, rates of involuntary admissions increased in subgroups of patients. It is unknown whether this is true in other European countries.

Aims

To establish whether the increase in emergency commitments was uniform across subgroups of patients and dangerousness criteria used to justify commitment in The Netherlands.

Method

National data on all commitments in the period 2000–2004.

Results

Commitments increased from 40.2 to 46.5 (16%) per 100,000 inhabitants. Controlling for population changes in age and sex, relatively large increases were found in patients over 50 years (25–40% increase), in patients with dementia (59%), ‘other organic mental disorders' (40%) and substance abuse (36%). ‘Arousing aggression’, increased most strongly as a dangerousness criterion for commitment (30%).

Conclusion

Changing patterns of commitments in The Netherlands and England might indicate a wider European shift in diagnoses and reasons for admission of committed patients.

Introduction

The rate of involuntary admissions has increased in a number of European countries (Priebe et al., 2005, Salize and Dressing, 2004). This might be due to various factors, including an increase in the total number of admissions or a greater awareness of risk management in psychiatrists, resulting in psychiatrists detaining more patients who are a potential danger to the public (Mulder, Broer, Uitenbroek, Hemert, & Wierdsma, 2006). In England, the rise in rate of involuntary admission has been greatest in subgroups of patients: younger men, certain ethnic minority groups, and people with dementia (Lelliott & Audini, 2003). It is unknown whether there were changes in the reasons for commitment, since this information was not collected. The aim of this study was to investigate changes in demographic or diagnostic characteristics of committed patients in the Netherlands and whether there were changes in dangerousness criteria related to danger to the public, used to justify commitment.

Section snippets

Methods

This study examined changes in numbers of emergency involuntary admissions and characteristics of committed patients (age, gender, diagnoses and dangerousness criteria) in the period 2000–2004, using a national database in which all emergency involuntary admissions were registered.

Characteristics of involuntary admitted patients

The total number of all involuntary admissions during the period 2000–2004 was 34,979. 34.1% of these patients were committed more than once. The mean age of all committed patients was 40.9 years (SD 17.0), and 54% were men. The following diagnoses were most prevalent: psychotic disorders (48.3%), mania (17.9%), depressive disorders (10.7%), and personality disorders (5.5%). Suicide risk and violence to others were the most prevalent reasons for commitment (in 38.3 and 24.6% of all admissions,

Overall changes in rates of emergency involuntary admissions

The number of emergency involuntary admissions rose by 16% (from 40.2 to 46.5 per 100,000 total population) during the years 2000–2004 in the Netherlands. During this period, there were no changes in mental health law. Increases in involuntary admissions over time have been reported in other countries, such as England and Germany (Lelliott and Audini, 2003, McGaha et al., 2002, Priebe et al., 2005, Salize and Dressing, 2004). For example, in England, the number of detentions under civil

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