Résumé
Background: At times, there is even a need for community involuntary treatment which may help in reducing the hospital admissions of patients with mentally illness. In India, there are very few State run psychiatric hospitals where patients get admitted and treated under section 20 of MHA 1987. There should be provisions for treating mentally ill in the community, if needed involuntarily. Detention of mentally ill for treatment during the time of florid psychosis is not a permanent solution for mental illness treatment. With the existing medicines these illnesses cannot be cured but can be controlled. So it leaves us with the option of using such detention only when no other method to treat is practicable. Such detention should best in the interest of the patient and the community. Aims: This study was an attempt to explore the practical problems in reintegrating the mentally ill back in to the community after their involuntary admission in comparison with the voluntary admission. Methods: This is a cross sectional study and data was collected from the medical records of 113 patients who were admitted in this hospital during the period of January 2010 to June 2010. Nearly 470 voluntary patients’ records were analysed during the above said period but by randomization they were limited to nearly 113 to equate with the involuntary admission. Results: Median duration of total hospitalization period in involuntary admission group of patients is 108 days with a minimum of 15 days and maximum of 460 days of admission. Median duration of involuntary stay at hospital is 91 days in some patients in whose reception orders there was a clear mention of what should be done after their treatment and recovery. In comparison to this group median duration of involuntary stay in others is 113 days as there was no clear mention in their reception orders about what should be done after their treatment and recovery. Conclusion: Most of the hospitals do not have any community social worker who can liaise with the family members to address their fears and to facilitate their early reintegration back in to home. There is a need for a review board consisting judiciary and medical personnel which can revoke the reception order at any point of time to minimize through duration of involuntary hospitalization in closed wards. Key message: Mentally ill patient rights need to be protected.
Résumé
Back ground: In our day to day work, especially in government hospitals we come across involuntary admissions where it is difficult to discharge them. Aim: To study the 1)socio demographic factors, 2)symptom profile during admission, 3)referral mode, 4) previous admissions, 5)diagnosis, and 6)co morbidity; of the patients admitted in the open and closed wards of a tertiary level psychiatry hospital. Methods: Collecting the information on socio-demographic profile, presentation, diagnosis and management details of the patients from the case sheets in a semi structured proforma. The data so collected is analyzed statistically to determine any significance. Results: Involuntary (closed ward) admissions were determined by various factors, such as education, marital status, caste, economic status, family structure, social support, referral mode, first consultation, duration of untreated illness, substance abuse and symptom profile. Conclusions: Involuntary admission in India is determined by factors which are not similar to other countries. Policies should be made based on large scale Indian studies.