Rates for civil commitment to psychiatric hospitals in Norway. Are registry data accurate?

Civil commitment rates to psychiatric hospitals in Norway are among the highest in Europe. However, published rates are based on registry data of uncertain quality. Civil commitment at four psychiatric hospitals were examined and the quality of registry data assessed. We examined 2043 admissions, recorded the duration of deprivation of liberty and calculated incidence rates for civil commitment. The overall study generated incidence rate for civil commitment based on "involuntary referrals", "treatment periods" and persons involved were 259, 209 and 186 per 100,000 adults/year, respectively. For patients admitted for involuntary observation only, the mean duration of deprivation of liberty was 8.5 days, compared with 34.3 days for those admitted for long-term detention, representing 37.8% and 86.6% of the total inpatient period, respectively. The submitted records to the Norwegian Patient Registry (NPR) were incomplete and had missing information at two of the four hospitals. Moreover, when official civil commitment rates based on the NPR data were computed, almost 30% of all admissions were routinely excluded. Civil commitment in this study was higher than corresponding figures based on registry data. In general, civil commitment rates as reported by the NPR seem to be an underestimate.