Compulsory psychiatric treatment checklist: Instrument development and clinical application

Area of Science:

• Psychiatry and Mental Health Law
• Clinical Psychology
• Psychometric Instrument Development

Background:

• Limited availability of validated instruments for assessing compulsory psychiatric treatment (CPT).
• Need for objective tools to support clinical decisions regarding involuntary mental health care.

Purpose of the Study:

• To develop and validate the Compulsory Treatment Checklist (CTC) for evaluating the necessity of CPT.
• To establish the psychometric properties and clinical utility of the CTC.

Main Methods:

• Development of a 25-item CTC with four clusters: Legal, Danger, Historic, and Cognitive.
• Internal validation using Confirmatory Factor Analysis (CFA) and Multilevel Logistic Regression (MLL).
• Receiver Operating Characteristic (ROC) analysis to determine the optimal cut-off score.

Main Results:

• The CTC demonstrated a robust bifactor model structure, with a strong General factor.
• High reliability for the General factor (88.4%); subscale reliability was low.
• Each CTC item increase raised the odds ratio for CPT by 1.26 (p<0.001).
• A cut-off score of 23.5 achieved 90% accuracy, with 75% sensitivity and 93.6% specificity.

Conclusions:

• The CTC is a reliable and valid instrument for assessing compulsory psychiatric treatment necessity.
• The proposed cut-off score of 23.5 provides a strong basis for clinical decision-making.
• An improved 20-item CTC version may enhance clinical decisions and patient care for severe psychiatric disorders.