A psychiatrist colleague here in Seattle at the University of Washington Medical School is interested in the wording of laws in the UK and the European Community which govern involuntary treatment. What is the criteria for committing a person to the hospital against their will? Who has the power to take such action? What are the sfae guards on the person's civil and human rights? Please post any suggestions you might have on finding this information and or email me directly with your thoughts. Craig Rennebohm

In Ireland the legislation changed in 2001. Now to commit someone they have to be suffering from a mental disorder where
a. because of illness, disability or dementia there is a serious likelihood of the person concerned causing immediate and serious harm to himself or herslf or to otehr persons. or bexcause of the severity of the illness, disability or b. dementia the judgement of the person concerned is so impaired that failure to admit the person to an approved centre would be likely to lead to a serious deterioration in his or her condition or would prevenet the administration of appropriate tretmetn that could be given only bu such admisssion and the reception, detention and treatment of the person concerned in an approved centre would be likely to benefit or alleviate the condition of that person to a material extent.

Safeguards:

Someone has to apply for involuntary admission.
A doctor (GP usually) has to recommend admission (fill in form)
A consultant psychiatrist has to recommend admission.
The patient has right to appeal to mental health tribunal to reverse committal and a right of appeal exists to the circuit court.

Moderator Comment: Please see Documents & Files Section for relevant documents from Austin on this topic.

Post edited by: Suzanne, at: 2008/03/17 23:40

In Norway there’s a whole field of laws regulating involuntary treatment (meaning with medications) and involuntary admissions. Called "Law of psychiatric care".

INVOLUNTARY ADMISSION / HOSPITALISATION
1) A physician is required to examine the patient prior to admission.
If the patient refuses the examination (doesn’t want to see the doctor), a written resolution
from the head community doctor is needed to go on with the examination.

2) There are two levels of involuntary admissions:

A) Involuntary observation for a maximum of 10 days:
If one has strong reason to suspect that the patient is suffering
from a serious mental (psychotic) illness, but has to little
knowledge about the patient to be completely sure(for instance;
psychosis because of intoxication from drugs and suicidal
patients)

Involuntary admission:
If the patient has a known chronic serious mental (psychotic)
illness (like schizophrenia) AND one of the listed conditions are
present:
a)It’s very likely that the patient will reduce his /her chances of
getting much better without admission, OR it is very likely that
the persons condition in a very near future will be much worse, OR
b)is putting his/her or other peoples life in danger

In both cases (A and , the following criteria must be met:
a) voluntary treatment has been attempted without any results
b) The patient has been examined by two doctors (one prior to
admission and independent of the hospital in question), and one at
admission) (In addition a specialist in psychiatry at the hospital
needs to evaluate the criteria for the admission after another
independent examination within 24 hours)
c) The hospital / institution is professionally and materially able to
provide the help needed (in addition only psychiatric hospitals
institutions are qualified / permitted to admit people for
involuntary care)
d) The patient has been given the opportunity to speak for him- /
herself
e) Even if all these criteria are met, involuntary admission can only be
permitted if this is considered to be the overall best solution
for the patient.

The patient or his / her next of kin have the right to appeal against this decision to the local authorities (special appointed committees).

In addition one can ask to be admitted “voluntarily involuntarily”. That means that the patient can make an agreement with the hospital that they can hold him / her against their will for a maximum of 3 weeks if they change their mind about the admission before the treatment is completed.

If one is admitted voluntarily to the hospital, it is not permitted to change the voluntary status of the patient while he / she is admitted to hospital, even if the person is getting much worse and is refusing treatment. An exception to this is if the situation requires action permitted by principle of necessity (jus necessitatis)

INVOLUNTARY TREATMENT WITH MEDICATION
Is another chapter with specific strict regulations, and considers primarily antipsychotic treatment for severely psychotic people.

In England the situation is very like that in Ireland. We talk about "Sectioning" a patient which refers to sections of the Mental Health Act of 1983. The commonly used sections are 2 which lasts up to 28 days for assessment and 3 which lasts up to 6 months for treatment. For both types 2 doctors have to assess the patient and sign the papers, one is usually the GP and should have prior knowledge of the patient, the other is a psychiatrist and has to be specially approved under the mental health act to carry out this function. As well as the two dr's there has to be an Approved Social Worker (ASW) also specially trained and licensed who has the task of advocating for the patient, exploring any alternatives to compulsory admission (such as community treatment) and has to liaise with next of kin and take their views into account. All three people have to sign the paper for it to be legal. The patient then has the option of appealing to a Mental health tribunal, consisting of psychiatrists and lay representatives who can overturn the original decision and release the patient. Essentially the decision rests on the patient posing a significant risk to themselves or others as a result of a serious mental illness. The mental health act has recently been amended and we are absorbing the consequences of this, the main change seems to be that the mental illness does not have to be treatable - which has raised concerns amongst psychiatrists that they may become responsible for indefinitely detaining patients with personality disorder on the grounds that they may at some stage pose a risk to others.