Involuntary psychiatric hospitalizations trending upwards

Involuntary psychiatric hospitalizations jumped over 65% over a 10-year period in British Columbia. The biggest increases were seen in women, and among people with substance use disorders, according to a study in the Canadian Journal of Psychiatry. The study is one of only a few conducted over the past several decades investigating involuntary psychiatric hospitalizations in Canada, said its coauthor Will Small, an associate professor in the Faculty of Health Sciences at Simon Fraser University. In fact, the most recent national study for Canada examining involuntary hospitalization is from the 1970s. Other studies have been limited to specific hospitals, patient populations and regions. “Involuntary admissions are tracked fairly well in the healthcare system and by the provinces. I think the reporting on how often they’re being used and trends is probably what’s been lacking,” he said. Generally, between 2008 and 2017, involuntary hospitalizations increased in 11 Western European countries, but decreased in four Nordic countries, but remained constant in New Zealand and Italy. “Tracking trends is important for planning services, assuring reasonable access, and improving healthcare systems,” Small told the Medical Post in an interview. The topic of involuntary admissions has been in the public eye recently due to more awareness around issues related to gaps in patient rights and systemic problems. Another issue is the growing opioid drug crisis and resultant deaths which has led to debate around whether or not involuntary admissions should be strengthened or if other approaches are needed, he said. It’s a complex issue and research can help identify where attention is most needed. The study was conducted using provincial health administrative data. Hospitalization data, demographic information and reports (which is mandatory) of involuntary hospitalizations were examined for people aged 15 and older hospitalized between April 1, 2008, and March 31, 2018. During this time, B.C.’s overall population grew 15.2% from 4.3-million to 5-million people – but the researchers took that into account. It was found that in 2008, involuntary hospitalizations accounted for 44.6% of all hospitalizations for mental and substance use disorders (MSUDs) and jumped to 57% by the end of 2018. At the same time, voluntary admissions for MSUDs increased from 17,651 to 17,751 – a negligible increase representing only 0.5% of psychiatric hospitalizations. Also, over the 10-year period, the number of involuntary hospitalizations increased a dramatic 65.7% (from 14,195 to 23,531), and those involving police apprehension increased 128.7% (from 3,502 to 8,009). The increase in police-related admissions may be due to a growth in police encountering people in crisis and are in need of admission as a result of wider system issues such as homelessness, worsening of mental health conditions and other issues, he said The study found that between 2009 and 2015, the number of calls to police which involved people with severe mental illness grew about 9.7% per year in the Fraser Health system alone. The high levels of police involvement in psychiatric admissions puts police into the position of being front-line mental health responders which they are often not trained for, and is considered a misuse of police resources, Dr. Small said. There is a need to strengthen the voluntary system of care with increases in involuntary hospitalizations likely being the result of unmet care needs. As it stands, numerous gaps exist including the fact over a million people in B.C. have no primary care doctor, plus psychiatry and psychological services are either not available or difficult to access, Dr. Small said. Such gaps contribute to people with mental health issues reaching a crisis, using more emergency room services, and encountering the police in crisis situations In 2018, the most common diagnosis for involuntary patients was mood disorders (25.1%), followed by schizophrenia (22.3%) and substance use disorders (18.8%). But over the study period, the greatest increase was attributed to substance use disorders (139%). There was also a dramatic increase in involuntary hospitalizations of young adults. Of this group, women aged 15 to 24 stood out with a more than two-fold increase, which was an unexpected finding. Indeed, over the 10-year period, prevalence among women in that age group grew 162%, compared to 81% in men aged 15 to 34, and 106% among adults 85 and older. The younger adults may be having greater difficulty with access because they are less experienced (having been recently diagnosed) and face more challenges in navigating access to various services. This may signal a need to change how services are offered, Small said. The issue of involuntary hospitalizations is a complex one with issues ranging from gaps in the system relating to patient rights, cultural differences, to instances where involuntary hospitalizations can save people’s lives (such as among those who are experiencing severe psychosis or are suicidal). Yet few studies have investigated province-wide data and trends, said Small. But there was a study from Ontario published in 2018 in BJPsych Open. It also found a province-wide prevalence increase of involuntary psychiatric hospitalizations. That study found an increase from 70.7% in 2009 to 77.1% in 2013. “We found a very high prevalence of involuntary psychiatric admissions—almost three-quarters of all hospital admissions,” the researchers wrote. Their study focused on adults aged 16 to 105 years from 2009 to 2013. It included a final sample size of 115,515 patients admitted to hospital over the study period, and of these 85,607 (74.1%) were admitted involuntarily. A total of 28,726 (33.6%) of those who were involuntarily admitted were released within 72 hours. It also found that people with recent police contact and immigrants were the most likely to experience involuntary admissions. “Although involuntary admissions may help prevent suicide and homicide among those at high risk, they represent a significant reduction in patient autonomy and are often considered unjustified by patients. Further research is needed on the impacts of short-term involuntary admissions,” the study said.

Involuntary psychiatric hospitalizations trending upwards

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