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Cited by 230Healthcare Decision-Making and RestraintsPsychiatric care and mental health servicesHistorical Psychiatry and Medical Practices

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Variations in patterns of involuntary hospitalisation and in legal frameworks: an international comparative study

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Sheridan Rains, Luke, Zenina, Tatiana, Dias, Marisa Casanova, Jones, Rebecca, Jeffreys, Stephen, Branthonne-Foster, Stella, Lloyd-Evans, Brynmor, Johnson, Sonia·2019·The Lancet Psychiatry
DOI 10.1016/s2215-0366(19)30090-2PMC PMC6475657
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Abstract

BACKGROUND: Rising annual incidence of involuntary hospitalisation have been reported in England and some other higher-income countries, but the reasons for this increase are unclear. We aimed to describe the extent of variations in involuntary annual hospitalisation rates between countries, to compare trends over time, and to explore whether variations in legislation, demographics, economics, and health-care provision might be associated with variations in involuntary hospitalisation rates. METHODS: We compared annual incidence of involuntary hospitalisation between 2008 and 2017 (where available) for 22 countries across Europe, Australia, and New Zealand. We also obtained data on national legislation, demographic and economic factors (gross domestic product [GDP] per capita, prevalence of inequality and poverty, and the percentage of populations who are foreign born, members of ethnic minorities, or living in urban settings), and service characteristics (health-care spending and provision of psychiatric beds and mental health staff). Annual incidence data were obtained from government sources or published peer-reviewed literature. FINDINGS: The median rate of involuntary hospitalisation was 106·4 (IQR 58·5 to 150·9) per 100 000 people, with Austria having the highest (282 per 100 000 individuals) and Italy the lowest (14·5 per 100 000 individuals) most recently available rates. We observed no relationship between annual involuntary hospitalisation rates and any characteristics of the legal framework. Higher national rates of involuntary hospitalisation were associated with a larger number of beds (β coefficient 0·65, 95% CI 0·10 to 1·20, p=0·021), higher GDP per capita purchasing power parity (β coefficient 1·84, 0·30 to 3·38, p=0·019), health-care spending per capita (β coefficient 15·92, 3·34 to 28·49, p=0·013), the proportion of foreign-born individuals in the population (β coefficient 7·32, 0·44 to 14·19, p=0·037), and lower absolute poverty (β coefficient -11·5, -22·6 to -0·3, p=0·044). There was no evidence of an association between annual involuntary hospitalisation incidence and any other demographic, economic, or health-care indicator. INTERPRETATION: Variations between countries were large and for the most part unexplained. We found a higher annual incidence of involuntary hospitalisation to be associated with a lower rate of absolute poverty, with higher GDP and health-care spending per capita, a higher proportion of foreign-born individuals in a population, and larger numbers of inpatient beds, but limitations in ecological research must be noted, and the associations were weak. Other country-level demographic, economic, and health-care delivery indicators and characteristics of the legislative system appeared to be unrelated to annual involuntary hospitalisation rates. Understanding why involuntary hospitalisation rates vary so much could be advanced through a more fine-grained analysis of the relationships between involuntary hospitalisation and social context, clinical practice, and how legislation is implemented in practice. FUNDING: Commissioned by the Department of Health and funded by the National Institute of Health Research (NIHR) via the NIHR Mental Health Policy Research Unit.

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Figure 1 Association between psychiatric beds and involuntary hospitalisation
Figure 1 Association between psychiatric beds and involuntary hospitalisationCC BY-NC-ND · PubMed Central
Figure 2 Association between GDP per capita, PPP, and involuntary hospitalisation GDP=gross domestic product. PPP=purchasing power parity.
Figure 2 Association between GDP per capita, PPP, and involuntary hospitalisation GDP=gross domestic product. PPP=purchasing power parity.CC BY-NC-ND · PubMed Central
Figure 3 Association between health-care spending per capita and involuntary hospitalisation
Figure 3 Association between health-care spending per capita and involuntary hospitalisationCC BY-NC-ND · PubMed Central
Figure 4 Association between proportion of foreign-born individuals and involuntary hospitalisation
Figure 4 Association between proportion of foreign-born individuals and involuntary hospitalisationCC BY-NC-ND · PubMed Central
Figure 5 Association between absolute poverty and involuntary hospitalisation
Figure 5 Association between absolute poverty and involuntary hospitalisationCC BY-NC-ND · PubMed Central

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Metadata

Authors
Sheridan Rains, L., Zenina, T., Dias, M. C., Jones, R., Jeffreys, S., Branthonne-Foster, S., Lloyd-Evans, B., & Johnson, S.
Affiliations
  • University College London (GB)
  • King's College London (GB)
ORCID
Venue
The Lancet Psychiatry
Publisher
Elsevier BV
Published
2019-05
Volume
6
Issue
5
Pages
403-417
ISSN
2215-0366 (ISSN-L)
DOI
10.1016/s2215-0366(19)30090-2
PMC
PMC6475657
OpenAlex
W2925635931
Cited by
230
References
14
Citations by year
2026: 27 · 2025: 37 · 2024: 47 · 2023: 30 · 2022: 33 · 2021: 30 · 2020: 16 · 2019: 10
FWCI
25.97
Type
journal article
Language
en
Open access
Licence
Locations
  • The Lancet Psychiatry (publishedVersion, cc-by-nc-nd)
  • PubMed Central (publishedVersion, cc-by-nc-nd)
  • PubMed (publishedVersion)
  • ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
  • UCL Discovery (University College London) (acceptedVersion)
Funders
  • National Institute for Health Research
  • National Health Research Institutes
  • UCLH Biomedical Research Centre
Topics
  • Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
  • Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
  • Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
Keywords
involuntary hospitalisation, psychiatric hospitalization, mental health law, cross-national comparison, mental health services, psychiatric hospital beds, health care spending, GDP per capita, poverty, foreign-born population, ethnic minorities, urbanization, cross-national variation, mental health policy, health care delivery, health care outcomes, mental health professionals
MeSH terms
Involuntary Treatment, Australia, England, Europe, Hospital Bed Capacity, Humans, New Zealand, Risk Factors, Incidence, Gross Domestic Product

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