Legislative differences may influence the characteristics of involuntary hospitalised psychiatric patients

Comprehensive reviews aimed at identifying factors associated with involuntary psychiatric hospitalisation (IPH) have recently been published,1–3 providing interesting and challenging results. In 2019, Walker et al. performed a meta-analysis and observed that IPH was associated, on an individual level, with male sex, single marital status, unemployment, receiving welfare benefits, being diagnosed with a psychotic disorder or bipolar disorder, previous IPH, perceived risk to others, positive symptoms of psychosis, reduced illness insight, reduced adherence to treatment before hospitalisation and police involvement in admission.3 The studies included in the meta-analysis were performed in countries which have diverse legislation, criteria and procedures in relation to IPH. As the authors noted, such diversity in legal and health-care systems may have contributed to the heterogeneity of results.3 Taking this into consideration, it would be interesting to explore whether different IPH-related legislative criteria influence the individual factors associated with IPH. For example, as reviewed by several authors,4–6 there are countries in which a key criterion for IPH is the risk for patients to endanger themselves or other people, which implies a certain level of aggressiveness. In other countries, however, this is not a recognised factor relating to IPH, and other dimensions are considered instead, including the possibility of taking appropriate extra hospital measures, the capacity to provide consent and the need for urgent care. There are also countries in which IPH can be implemented only in relation to psychotic disorders, while in other countries it can be implemented in relation to severe mental disorders in general (this may or may not include substance use disorders).4–6 It is possible that such legislative aspects can contribute to influence the qualitative characteristics of patients undergoing IPH, as indirectly suggested by studies showing marked quantitative differences in IPH rates between countries.2,7 Subsequently, while the findings of the recently published meta-analysis3 are extremely novel, relevant and enriching, we believe that studies on the risk factors for IPH taking into consideration the underlying legislation systems should be encouraged. Although we are aware of the difficulties of such an approach, this would provide additional information that could be readily transferred to clinical settings.