The Involuntary-To-Voluntary Hospitalization Transition and the Risk of Psychiatric Decompensation: A Retrospective...

Involuntary hospitalization of a patient with a mental disorder is broadly defined as the admission to an inpatient unit without the patient's consent. Literature suggests that involuntary hospitalizations are associated with low levels of treatment satisfaction, avoidance of mental health care, and an increased risk of emergency involuntary re-hospitalization. Despite being a lifesaving treatment, involuntary admissions can also be stigmatizing, undermine the long-term therapeutic relationship and reduce adherence to care. In this context, little research has been conducted to evaluate how shifting a patient's hospitalization from involuntary to voluntary affects health outcomes, such as psychiatric decompensation and healthcare use. The main aim of this study was to identify and assess the frequency of readmissions within one year among patients who transitioned to voluntary treatment, compared with those who remained involuntarily treated.

An observational retrospective study was conducted using secondary data from medical records of adult inpatients involuntarily admitted to the inpatient psychiatry department of Unidade Local de Saúde São João. All involuntary hospitalizations occurring between January 1st and December 31st, 2022, were classified into two distinct groups: patients who were initially admitted involuntarily and subsequently converted to voluntary hospitalization during their stay or patients who remained under involuntary hospitalization until discharge. Data registered in medical records within one year after the index hospitalization was collected and assessed (whether structured data or free text entries). Descriptive and comparative analyses were performed.

A total of 120 patients were included. More patients converted to voluntary hospitalization (60.8%) than remained involuntarily hospitalized (39.2%). In comparison to voluntary inpatients, involuntary inpatients had significantly higher readmission rates within one year (36.2% vs 15.3%, p = 0.009) and were more often readmitted under involuntary status (88.2% vs 45.5%, p = 0.030).

Involuntary hospitalization was associated with worse outcomes within one year, underscoring the need for its use to be proportional to the risk and subject to periodic review. Conversion to voluntary hospitalization is reasonable, respects patient autonomy and, provided that appropriate treatment is maintained, does not worsen psychiatric decompensation.