[Independent psychiatrists rarely dispute an application for compulsory admission]

In recent years in the Netherlands there has been a marked increase in the number of compulsory admissions, particularly those that require court authorisation. Little is known about the decision-making process that precedes the issuing of a court authorisation for compulsory admission.

To obtain more insight into the factors that an independent psychiatrist has to consider when assessing whether he or she should sign a medical certificate that will advise on compulsory admission.

Data on clinical and demographic patient characteristics were gathered for 862 commitment applications. Motives for rejection of the application or doubt about the necessity of commitment were collected. results In the case of 9% of the applications, the psychiatrist hesitated about the need for compulsory admission but nevertheless signed the necessary medical certificate. In the case of 3% of the applications, the psychiatrist turned down the application for compulsory admission. The psychiatrist found to reject or query an application less often if a patient presented a direct physical threat to himself or others. The principal reason for rejecting an application for compulsory admission was the possibility that an alternative type of treatment was available.

In principle the independent psychiatrist nearly always signs a medical certificate if the clinician treating the patient had requested a court authorisation. Factors that might help to reduce the number of court authorisations are better and earlier use of intensive care services, improved management or the deployment of legal restraints to prevent danger.