Relationship between involuntary admission and the therapeutic process in a closed ward functioning as a therapeutic...

In a therapeutic community for acute psychiatric patients, the relationship between involuntary admission (13.6% of the episodes) and some patient and program characteristics was analyzed, using a total of 1586 treatment episodes in 838 patients between 1978-1987. Based on a logistic regression model, an elevated relative risk of involuntary admission was seen in the diagnostic groups of schizophreniform psychosis, unspecific psychosis, paranoid psychosis, and borderline psychosis. Also, the association with involuntary admission increased in the first or second treatment episode, or for patients that had a controversial or negative immediate outcome, for young patients under 21 years, and for patients who were passive in individual therapy. Still, the difference in outcome was minimal, and there were no differences in group or milieu therapy activity. The results suggest that involuntary admission is not necessarily a traumatic, negative experience in subsequent treatment episodes or in the patient career. The modified therapeutic community model presented contains peer and family support and ample opportunity to discuss and negotiate, which may alleviate the possible narcissistic pain of involuntary admission.