The impact of involuntary-to-voluntary hospitalization transitions on psychiatric decompensation: a retrospective cohort study

Abstract

Introduction: Involuntary hospitalization of a patient with a mental disorder is broadly defined as admission to an inpatient unit without consent. Literature suggests that involuntary hospitalizations have been associated with low levels of treatment satisfaction, avoidance of mental health care, and an increased risk of emergency involuntary re-hospitalization. Despite being a lifesaving treatment, involuntary admissions can also be stigmatizing, undermine the long-term therapeutic relationship and reduce adherence to care. In this context, little research has been conducted to evaluate how switching a patient's hospitalization from involuntary to voluntary may impact health outcomes, such as psychiatric decompensation. Objectives: To compare the 1-year frequency of hospital readmission of patients who switched to voluntary hospitalization with those who remain under involuntary hospitalization, and to analyze sociodemographic characteristics and prognostic outcomes of both groups. Methods: An observational retrospective study was conducted using clinical data of 120 patients involuntarily admitted to inpatient psychiatry of Unidade Local de Saúde São João. All involuntary hospitalizations spanning from January 1, 2022, and December 31, 2022, were categorized into two groups: patients who switched to voluntary hospitalization or patients that maintained involuntary hospitalization. Data registered in medical records within one year after the index hospitalization was assessed (whether structured data or free-text). Descriptive and comparative analyses were performed. Results: In our sample, there were more patients that switched to voluntary hospitalization (60.8%) than patients that maintained involuntary hospitalization (39.2%). In comparison to voluntary discharged patients, involuntary discharged patients were significantly associated with more readmissions within one year (36.2% vs 15.3%) and they were more often readmitted under involuntary status (88.2% vs 45.5%). Conclusions: Involuntary hospitalization should only be used when it is proportional to the risk posed and should be periodically reviewed. The process of specialist re-evaluation in switching to voluntary hospitalization is reasonable and honors the patient's autonomy, provided that appropriate treatment is ensured, without worsening psychiatric decompensation.