Clinical and Demographic Features of Voluntary and Involuntary Admissions under Ireland's Mental Health Act, 2001: The Dublin Involuntary Admission Study (DIAS), 2008-2018

Abstract

Involuntary admission and treatment are common, long-standing features of psychiatry but the relationships between diagnosis, demographic factors and other elements of involuntary treatment are not clear. Involuntary admission rates vary widely internationally. Involuntary treatment in Ireland takes place under the Mental Health Act 2001. This is a retrospective study of admissions to three acute psychiatry units in Dublin between 2008 and 2018. Of the 5,581 admissions studied, 84.7% (n=4,723) were voluntary and 15.3% (n=856) were involuntary. Though the proportion of admissions that were involuntary was higher than the national proportion during the study period, rates per 100,000 population were generally lower for overall, voluntary and involuntary admissions. Proportionately fewer admissions of women were involuntary compared to men. Among involuntary admissions, schizophrenia-group disorders were the most common diagnoses and accounted for a greater proportion of involuntary admissions among men than women. When schizophrenia-group admissions were examined, those with schizoaffective disorder were significantly more likely to be female and older, and less likely to be involuntary, compared to those with schizophrenia. This differential use of involuntary treatment between these two clinically similar disorders is noteworthy and may be attributable to the differing balance of affective and psychotic symptoms. Applications for involuntary admission in these urban units were most commonly made by ?members of the public?, largely Emergency Department staff, whereas nationally applications by family members were most common. Applications by police accounted for the second largest proportion of applications in our study and nationally. We did not find significant clinical differences between involuntary admissions with and without police involvement; non-clinical factors, such as homelessness, social exclusion or criminality might underlie police involvement. Police never used ?Section 9? as grounds for involuntary application in our study, raising the possibility that this option need not be retained. Psychiatrists signed involuntary orders on the grounds of ?treatability?, rather than ?risk? in the majority of cases. To our knowledge, this study is the longest detailed study of involuntary psychiatry admission in Ireland and adds to our understanding of the clinical and demographic factors underpinning involuntary status.