Post-legislation Research On Influencing Factors And Corresponding Strategies Of Involuntary Admissions In Patients With Mental Disorders

?Objective?On the basis of understanding the current situation of involuntary admission of patients with mental disorders in Shanghai following implementation of the new legislation,we explored the medical and non-medical influencing factors of involuntarily admitted patients,and preliminarily formulated guidelines for evaluation of patients with mental disorders on whether they should be hospitalized or not,so as to provide scientific support for improving local mental health legislation and regulations,and better safeguarding the rights and interests of doctors and patients.?Methods?This study combined quantitative and qualitative research.After investigating involuntary admission status of psychiatric patients in Shanghai following promulgation of the Mental Health Law,the study explored medical and non-medical influencing factors of involuntary admission respectively.On the basis of early studies,the manual of operational guidelines for involuntary admission evaluation were initially formulated:1.Study on the medical influencing factors of involuntary admission of psychiatric patients.Longitudinally investigate status quo of involuntary admission of patients with mental disorders in Shanghai within one year after legislation,and then comparatively analyze medical influencing factors of voluntary and involuntary admissions of patients with mental disorders through crosssectional study;2.Study on non-medical influencing factors of involuntarily admitted patients from two perspectives of family caregivers and psychiatrists.This section investigated the influencing factors of family caregivers on decision-making of involuntarily admission by semi-structured interviews,and explored influencing factors of psychiatrists' decision-making on involuntary hospitalization through Delphi method;3.On the basis of previous study and expert consultation,the operational guidelines for involuntary admission assessment of psychiatric patients were preliminarily developed.After smallsample testing,content adjustment and critical value of assessment were carried out.?Results?1.Within one year following the promulgation of the Mental Health Law,the rate of involuntary admission of psychiatric patients has declined with the most obvious decrease(about 20%)in the first month.However,involuntary admission remains common in mental health institution,and the rate of involuntary admission increased over time and even approaching prelegislative level.About 10% out of all involuntarily admitted patients did not meet risk criteria of involuntary admission in the new mental health law.2.The medical influencing factors of involuntary admission in psychiatric patients include aggressive behaviors,insight status and admission diagnosis,which are basically consistent with previous studies at home and abroad.3.The main non-medical influencing factors affecting involuntary admission of psychiatric patients are the willingness of family caregivers rather than psychiatrists' suggestions.Main factors affecting the decision-making of family caregivers/guardians are impacts of patients' illness on daily life,judgements and response of family caregivers to patients' status,social support and avoiding the outside world.In the same scenario,different doctors may make different suggestions on hospitalization.Except for legislation,a series of factors,such as psychiatrists' explanation of risk criteria of involuntary admission,medical role positioning,influence of family caregivers' willingness and medical management,affect psychiatrists' suggestions on involuntary admission.4.This section completed "Operational Guidelines for Involuntary Admission Assessment of Patients with Mental Disorders".The operational guidelines combined risk criteria on involuntary admission in the new Mental Health Law,and quantified and integrated the evaluation items of psychiatrists,patients and their caregivers.The guideline applies to adult patients with mental disorders.Psychiatrists could evaluate the situations of patients through 13 items including the right of patients to the situation.The weight coefficient of the patients' status is 0.8333,and weight coefficient of caregivers' status is 0.1667,which accords with the original assumption of this study about restricting the influence of family caregivers' willingness on hospitalization decision-making.The operational guidelines are concise,practical and in line with the psychiatrists' operating habits.They can assist psychiatrists to make more reasonable hospitalization suggestions and make suggestions more objective.?Conclusions?1.Although the rate of involuntary admission of psychiatric patients in Shanghai decreased after mental health legislation,involuntary admission remains common in mental health institutions;2.Following implementation of the new mental health law,medical factors affecting involuntary admission of patients with mental disorders are basically consistent with previous studies at home and abroad.3.Following implementation of the new mental health law,non-medical factors mainly affected involuntary admission in patients with mental disorders,and family caregivers play a major decisive role in hospitalization decision-making;4.Semi-structured assessment would help psychiatrists make more reasonable hospitalization sugestions for patients with mental disorders and their family caregivers,and the suggestions are more objective.