Use of coercion in patients with first-episode psychosis: a retrospective cohort study of involuntary admissions, involuntary treatment orders and community treatment orders

Abstract

Aim: Coercion in mental health care is under constant debate. Norway has been shown to have relatively high rates of involuntary admissions. The use of coercion in patients with first-episode psychosis (FEP) in Norway is sparsely described, thus limiting an informative debate.

Method: We registered involuntary admissions, involuntary treatment orders, community treatment orders and other coercive measures during the first two years of treatment for all patients diagnosed with a first-episode non-affective psychosis at St Olav's University Hospital from 2012 to 2016. The hospital serves the Sør-Trøndelag County with 313,370 inhabitants in 2016.

Results: A total of 238 patients with FEP were included. 40% of the patients were involuntary admitted at first contact leading to the psychosis diagnose, and during the first two years of treatment 53% of the patients were involuntary admitted. Of the involuntarily admitted patients, 43% were discharged on a community treatment order, and 34% had involuntary treatment orders. Other coercive measures, such as short-term holding, mechanical restraint or short-acting medication, were used in 21% of patients receiving inpatient treatment.

Conclusion: Involuntary admission was relatively common in this cohort of FEP patients, although less used than in previous studies from Norway. Compared to studies from other countries, our findings, along with those from Finland, show among the highest rates of involuntary admissions and involuntary treatment orders published, and are higher than findings in other Nordic countries such as Denmark and Sweden.

Keywords: FEP; First-episode psychosis; coercion; involuntary admissions.