How can variations in civil commitment rates within and between countries be understood?

Kjellin, Lars; Engberg, Marianne; Høyer, Georg; Kaltiala-Heino, Riittakerttu; Sigurjónsdóttir, Maria
January 2007
BMC Psychiatry;2007 Supplement 1, Vol. 7, Special section p1
Academic Journal
Background To compare civil commitment rates between different catchment areas in the Nordic countries and to explore how variations in civil commitment rates can be understood. Methods One psychiatric setting in Denmark, three in Finland, one in Iceland, four in Norway and three in Sweden participated in this part of the Nordic study on the use of coercion in the mental health care system. Data from medical records and related documents were registered for about 5,500 admissions of committed and voluntarily admitted patients in the years 1996-1999. A registration form specially designed for the study was used, including demographical and medical data and data on legal status for each admission. Information about the structure of the participating wards was collected separately. Results Nearly a tenfold difference was found between the catchment area with the highest and the area with the lowest civil commitment rate. Within countries, the greatest area variation was found between the three Swedish centers, with a threefold difference. The same magnitude of variation was found with regard to quotas of involuntary admissions, i.e. the proportion of civil commitments of all admissions. In preliminary analyses, no clear associations were found between civil commitment rates and demographic and clinical characteristics of the patients and organizational characteristics of the participating psychiatric wards. Conclusion Differences in legal prerequisites may be one factor explaining international variation in commitment rates, but predictors for variations within jurisdictions, with a uniform legislation, need to be further examined. The results of forthcoming analyses of the Nordic data will be presented.


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