Factors associated with involuntary mental healthcare in New South Wales, Australia
Open accessAbstract
Background: There is uncertainty about factors associated with involuntary in-patient psychiatric care. Understanding these factors would help in reducing coercion in psychiatry. Aims: To explore variables associated with involuntary care in the largest database of involuntary admissions published. Method: We identified 166 102 public mental health hospital admissions over 5 years in New South Wales, Australia. Demographic, clinical and episode-of-care variables were examined in an exploratory, multivariable logistic regression. Results: A total of 54% of eligible admissions included involuntary care. The strongest associations with involuntary care were referral from the legal system (odds ratio 4.98, 95% CI 4.61–5.38), and psychosis (odds ratio 4.48, 95% CI 4.31–4.64) or organic mental disorder (odds ratio 4.40, 95% CI 3.85–5.03). There were moderately strong associations between involuntary treatment and substance use disorder (odds ratio 2.68, 95% CI 2.56–2.81) or affective disorder (odds ratio 2.06, 95% CI 1.99–2.14); comorbid cannabis and amphetamine use disorders (odds ratio 1.65, 95% CI 1.57–1.74); unmarried status (odds ratio 1.62, 95% CI 1.49–1.76) and being born in Asia (odds ratio 1.42, 95% CI 1.35–1.50), Africa or the Middle East (odds ratio 1.32, 95% CI 1.24–1.40). Involuntary care was less likely for people aged >75 years (odds ratio 0.68, 95% CI 0.62–0.74), with comorbid personality disorder (odds ratio 0.90, 95% CI 0.87–0.94) or with private health insurance (odds ratio 0.89, 95% CI 0.86–0.93). Conclusions: This research strengthens the evidence linking diagnostic, socioeconomic and cultural factors to involuntary treatment. Targeted interventions are needed to reduce involuntary admissions in disadvantaged groups.
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Data from NSW inpatient admissions found information regarding patient legal status was missing from 3.8% of records of inpatient psychiatric admissions.
“While no studies have examined this phenomenon in an Australian setting, data from NSW inpatient admissions found information regarding patient legal status was missing from 3.8% of records of inpatient psychiatric admissions (16).”
From The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review (2025) · cites this paper as [16]
The Results report that 6606 of 172,712 in-scope NSW admissions (3.8%) had no valid legal status recorded. The Limitations clarify that this figure includes episodes with missing *or invalid* legal status, so it does not establish that information was missing from all 3.8% of records. (LLM, conf=0.88)
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The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review
Corderoy, A., Kisely, S., Zirnsak, T., & Ryan, C. J. (2025) · Psychiatry, Psychology and Law · doi:10.1080/13218719.2024.2346734 · Cited by 19 · see citing works
“While no studies have examined this phenomenon in an Australian setting, data from NSW inpatient admissions found information regarding patient legal status was missing from 3.8% of records of inpatient psychiatric admissions (16).”
InfluentialSelf-citation
- Authors
- Corderoy, A., Large, M. M., Ryan, C., & Sara, G.
- Affiliations
- UNSW Sydney (AU)
- The University of Sydney (AU)
- Corresponding author
- Sara, Grant
- Venue
- BJPsych Open
- Publisher
- Royal College of Psychiatrists
- Published
- 2024-03
- Volume
- 10
- Issue
- 2
- Pages
- e59-e59
- ISSN
- 2056-4724 (ISSN-L)
- PMC
- PMC10951846
- OpenAlex
- W4392373678
- Cited by
- 11
- References
- 20
- Citations by year
- 2026: 5 · 2025: 4 · 2024: 2
- FWCI
- 1.37
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- BJPsych Open (publishedVersion, cc-by)
- SSRN Electronic Journal (publishedVersion)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Psychiatry and Mental health › Electroconvulsive Therapy Studies
- Keywords
- involuntary psychiatric admission, coercion in mental health care, psychosis, organic mental disorders, substance use disorders, mood disorders, legal referral, personality disorder comorbidity, socioeconomic factors, cultural factors, New South Wales, mental health policy, deinstitutionalization, private health insurance, older adults, unmarried status
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