Voluntary or involuntary acute psychiatric hospitalization in Norway: A 24 h follow up study

The Norwegian Mental Health Care Act states that patients who are involuntarily admitted to a hospital must be reevaluated by a psychiatrist or a specialist in clinical psychology within 24 h to assess whether the patient fulfills the legal criteria for the psychiatric status and symptoms. International research on the use of coercive hospitalization in psychiatry is scarce, and an investigation of Norway's routine re-evaluation of involuntarily referred patients may expand knowledge about this aspect of psychiatric treatment. The aim of this study was to investigate the extent to which Involuntarily Hospitalized (IH) patients were converted to a Voluntary Hospitalization (VH), and to identify predictive factors leading to conversion. The Multi-center Acute Psychiatry study (MAP) included all cases of acute consecutive psychiatric admissions across twenty Norwegian acute psychiatric units in health trusts in Norway across 3 months in 2005–06, representing about 75% of the psychiatric acute emergency units in Norway. The incident of conversion from involuntarily hospitalization (IH) to voluntary hospitalization (VH) was analyzed using generalized linear mixed modeling. Out of 3338 patients referred for admission, 1468 were IH (44%) and 1870 were VH. After re-evaluation, 1148 (78.2%) remained on involuntary hospitalization, while 320 patients (21.8%) were converted to voluntary hospitalization. The predictors of conversion from involuntary to voluntary hospitalization after re-evaluation of a specialist included patients wanting admission, better scores on Global Assessment of Symptom scale, fewer hallucinations and delusions and higher alcohol intake. Conclusion The 24 h re-evaluation period for patients referred for involuntary hospitalization, as stipulated by the Norwegian Mental Health Care Act, appeared to give adequate opportunity to reduce unnecessary involuntary hospitalization, while safeguarding the patient's right to VH.