[From psychiatric hospital to residential home for younger psychiatric patients. A cross-over study of residents in Sundbygaard in Copenhagen]]. / Fra psykiatrisk plejehospital til bocenter for yngre sindslidende. En tvaersnitsundersøgelse af beboerne på institutionen Sundbygård i København.

Along with the implementation of community psychiatry, an increasing number of younger psychiatric patients live in social institutions, with psychiatric treatment offered on a consultation basis. On the basis of hospital records and interviews with staff members, the study describes two groups of patients in a former psychiatric nursing hospital, group 1 offered time-limited stay with the aim of social rehabilitation, and group 2 offered permanent stay. Patients of group 1 were younger and more frequently treated with atypical antipsychotics. Apart from this, no differences were found. The vast majority of both groups suffered from schizophrenia. The intensity of symptoms was high, despite extensive medication. The two groups might represent the same category of the most severely disabled patients, seen at different ages. More intensive psychiatric consultant service is found necessary, and the process of rehabilitation should be evaluated prospectively.

[The use of involuntary commitment and other compulsory treatment in psychiatry. A study of registered compulsory treatment, physical restraint and the use of physical force]. / Lov om frihedsberøvelse og anden tvang i psykiatrien. En undersøgelse af registrering af tvangsbehandling, tvangsfiksering og anvendelse af fysisk magt.

The study covers nine psychiatric hospitals in Denmark that together account for 20% of all admissions to mental hospitals in the country. The period of investigation was from 1. January 1990 to 31. December 1991. Compulsory treatment, mechanical restraint and physical coercion were investigated. The number of patients that are submitted to compulsory treatment is relatively small compared to the total number of patients admitted to psychiatric hospitals. The use of the different kinds of coercion may among other factors depend upon the severity of the patient's disease, the bed occupancy and the amount of staff available including the number of doctors. The study shows differences among the participating departments in the use of mechanical restraint with wrist and/or ankle cuffs but not with a waist-belt. This may depend more upon different traditions on the wards than upon demographic differences. According to Danish law a doctor must attend a patient experiencing mechanical restraint. In an emergency situation the staff are permitted to effectuate the restraint without the doctor being present but a doctor must see the patient immediately afterwards and sign a protocol. This was the case in only about one third of all cases.

[The law on involuntary commitment and other detaintment in psychiatry. A study of registered involuntary commitments]. / Lov om frihedsberøvelse og anden tvang i psykiatrien. En undersøgelse af registrering af frihedsberøvelser.

The hospitals included in this study receive about 20% of all commitments to mental hospitals in Denmark. The investigation showed that 4% of the commitments were involuntary. The median time for involuntary detainment was 12 days. More than half of the patients who were committed on an involuntary basis experienced involuntary detainment. But 70% of all involuntary detainments were experienced by patients who were committed on a voluntary basis. The study suggests that a high bed occupancy rate together with poor out-hospital treatment of the patients might lead to a higher number of compulsory admissions. Other factors may be of importance but were not considered in this study. According to Danish law all compulsory admissions and detainments must be reviewed according to certain rules. The investigation showed that there were some irregularities concerning such reviewing. The number of staff members including doctors has not increased despite the fact that reviewing commitments and detainments takes a lot of time for the staff involved.

[Compulsory procedures at the Psychiatric Department, Frederiksberg Hospital, before and after introduction of the new psychiatric legislation. 3. Compulsory medication]. / Tvang udføort på psykiatrisk afdeling, Frederiksberg Hospital, før og efter indførelsen af den nye psykiatrilov. 3. Tvangsmedicinering.

The purpose of this investigation was to register if the new Danish law concerning commitment and compulsory procedures in psychiatry from 1.10.1989 caused changes in the extent of forced medications. During the period: 1.1.1988-30.9.1991 all compulsory procedures in the department of psychiatry, Frederiksberg Hospital, were registered. The number of patients medicated by force was unchanged, but after the law reform significantly fewer patients were medicated with depotpreparations and the duration of forced medication was significant longer. Twenty-three patients complained about the forced medication, one before and 22 after the law reform. For 18 patients the complaints put off administration of the forced medication, and they waited a total of 251 days for the complaints board to make a decision. The complaints board only agreed with one patient. The law reform has increased the public security for the psychiatric patients but did not as intended prevent or limit forced medication.

[Compulsory admissions to Frederiksberg Hospital after introduction of the new psychiatric legislation compared with the period just before the change of the law]. / Tvangsindlaeggelse på Frederiksberg Hospital efter den nye psykiatrilovs indførelse sammenlignet med perioden umiddelbart før lovaendringen.

The new Danish Act on confinement and other means of compulsion in psychiatry came into force October 1st, 1989. To investigate changes connected with the new act all involuntary commitments to the psychiatric department of the hospital of Frederiksberg, with a catchment area of 85,000 inhabitants, were prospectively registered during 23 months before, 25 months after the new legislation. Information about the commitment was obtained from the admission papers and the case records. The patients were asked to participate in an interview. Both before and after the new act there were about 35 commitments per year. There was a trend towards an increasing number of women being committed by reason of threat to the patient's health after the new act. No significant changes were observed regarding age, condition at admission, diagnoses, duration of hospitalization or condition at discharge. A little more than half of the committed patients participated in the interviews. The new act stressed the rights of the patients. In spite of this the patients did not express any increase in their understanding of or satisfaction with their hospitalization.

[Use of restraints in a psychiatric department, Frederiksberg Hospital, before and after introduction of the new psychiatric law. Restraining devices]. / Tvang udført på psykiatrisk afdeling, Frederiksberg Hospital, før og efter indførelsen af den ny psykiatrilov. Tvangsfikseringer.

The purpose of this investigation was to register if the new Danish law concerning commitment and compulsory procedures in psychiatry from 1.10.1989 caused changes in the use of restraints. During the period 1.2.1988-30.9.1991 all compulsory procedures in the Department of Psychiatry, Frederiksberg Hospital, were registered. A total of 145 patients were restrained during 167 admissions. No changes were registered in the number of restraints in connection with the law reform, but the duration of the fixations increased by 42%. The number of medications given forcibly in connection with the restraints increased significantly. One of the purposes of the the law reform was to reduce the number and duration of restraints. This purpose has not been fulfilled.

[Use of alternative treatment among hospital staff in a psychiatric and a rheumatology department]. / Brug af alternativ behandling blandt personalet ved en psykiatrisk og en fysiurgisk afdeling.

Staff members of a psychiatry and a rheumatology department were given a questionnaire concerning their use of alternative treatment. The response rate was 59% (111 of 187). Of 111 replies it was found that 48% had used alternative treatment at least once, while 23% had used alternative treatment within the 3 months preceding the interview. There were no significant differences in the use of alternative treatment in relation to sex or age. Only 22 had paid more than 1000 Dkr. for alternative treatment during their lifetime. The personnel's total expenses for alternative treatment within the last 3 months were 10,400 Dkr. paid by 19 members of the personnel. Compared to investigations of the general population this investigation indicated that the hospital staff had used alternative treatment more widely. Staff use of alternative treatment was at a similar level to that found in different patient group. If the way in which the staff relates to illness and treatment serves as a model for others, it cannot be expected that they counteract the use of alternative treatment.

[Compulsory procedures in the psychiatric department, Frederiksberg Hospital, before and after introduction of the new psychiatric legislation]. / Tvang udført på psykiatrisk afdeling, Frederiksberg Hospital, før og efter indførelse af den nye psykiatrilov.

Registration of compulsory procedures in a psychiatric department before and after the reform of the Danish law concerning commitment and compulsory procedures in psychiatry. The purpose of this investigation was to register if the law reform 01.10.1989 caused changes in the extent of compulsory procedures in a psychiatric department. The study was prospective. During the period: 01.02.1988-30.09.1991, all compulsory procedures in the department of psychiatry, Frederiksberg Hospital, were registered. A total of 289 patients had been subjected to compulsory procedures during 336 admissions. The compulsory procedures registered were: incarceration in the department, forced medication and restraint by a belt. The total number of admissions with compulsory procedures increased after the law reform. The number of incarcerations increased. No changes were registered in the number of restraints and forced medications in connection with the law reform but, two years after, increases of 37% and 74% respectively were registered. One of the main purposes of the law reform was to limit and, if possible, to prevent compulsory procedures. This purpose has not been fulfilled. The increase in the extent of compulsory procedures in the latter part of the observation period is probably caused by factors such as increase bed occupancy and decrease in resources.

[Compulsory admissions at the Frederiksberg hospital during the period 1 Nov 1987 to 30 Sep 1989. 1. Characteristics of the compulsory admissions and the admitted persons]. / Tvangsindlaeggelser på Frederiksberg Hospital i perioden 1. nov. 1987 til 30. sep. 1989. 1. Karakteristik af tvangsindloeggelserne og de tvangsindlagte.

During a period of 23 months from 1 Nov. 1987 to 30 Sep. 1989, before the new Danish legislation came into force, there were 64 compulsory commitments to the Psychiatric Department in Frederiksberg Hospital. These comprised 3.6% of all the admissions which corresponds to the national average in Denmark. Equally many were admitted on health grounds (yellow admission papers) and on account of danger (red admission papers). Women were admitted more frequently than men. The distribution corresponds to the sex distribution of all psychiatric admissions in Frederiksberg and reflects a sex distribution in the municipality with preponderance of women as compared with the national Danish average. On the Danish national basis, the majority of these admissions are men. One fourth of the admission papers did not contain an adequate description of the reasons for presuming mental illness and/or the danger or health criteria. There is thus reason to encourage meticulous care in completion of the medical certificates in cases of compulsory commitment. On discharge from hospital, 14% had a "non-psychotic" diagnosis, which corresponds to the national Danish average. One month after discharge from hospital, 40% were attending outpatient treatment in the department and one year later, 38% of those followed-up were receiving outpatient treatment. In more than one third, compulsory commitment was thus followed by a prolonged period of voluntary treatment. 33% were readmitted during the subsequent year and this was compulsory in 13%.

[Compulsory admissions at the Frederiksberg hospital during the period 1 November 1987 to 30 September 1989. 2. Patients' assessment and experiences of the admissions]. / Tvangsindlaeggelser på Frederiksberg Hospital i perioden 1. nov. 1987 til 30. sep. 1989. 2. Patienternes vurdering og oplevelse af tvangsindloeggelser.

The object of this prospective, descriptive investigation was to illustrate how the committed patients assessed and experienced the actual compulsory commitment and their assessment of the Danish legislation concerning mental illness by means of an interview investigation on discharge. During the period of investigation of 23 months, there were 64 compulsory admissions. Of these, 31 were on account of danger (red admission papers) and 33 on health grounds (yellow admission papers). Thirty-three (52%) patients were interviewed and of these 13 were admitted on account of danger and 20 on health grounds. Twenty-two (67%) of the patients did not realise that they were undergoing compulsory admission until the police came to fetch them. The majority considered that the functions of the police (68%), admission staff (55%) and the remainder of the staff (79%) had been good or satisfactory. 46% did not know who had demanded admission and did not ask the interviewer. 30% were satisfied with information about complaints. 42% were satisfied with the function of the supervisory committee but just under 30% did not realise that it existed. 61% considered that compulsory admission could have been avoided if other help had been offered. 61% were satisfied with the hospitalization. 64% considered that it is necessary to have legislation which permits compulsory admission. Relatively more of the patients admitted with red admission papers expressed satisfaction with, and accept of, their own compulsory admission and accept of compulsory admission in general. The present investigation will form a basis for comparison of the conditions under the new Danish legislation concerning mental illness.

[Alternative forms of treatment of psychiatric patients]. / Psykiatriske patienters brug af alternativ behandling.

In the Psychiatric Department of Frederiksberg Hospital, 115 of all 153 admitted patients were interviewed about their use of alternative treatment. Information obtained from the interviews was compared with data in the case records. Of the 115 patients interviewed, 42% had used alternative treatment at least once, while 17% had used alternative treatment within the past three months before the interview. Herbal medicine was the most frequent type of treatment. Nearly one half of the patients wanted treatment because of somatic problems. The frequency of alternative treatment decreased with age. Compared to the entire investigation group, those diagnosed as manic-depressive used alternative treatment more frequently, while schizophrenic patients used this kind of treatment less often. The patients most satisfied with the psychiatric department used alternative treatment less frequently. Use of alternative treatment was not related to duration of disease, or whether the patients were in the ward 24 hours or only during day-time. Only 19 of the 48 patients who had used alternative treatment had paid more than 1,000 Dkr. (approximately pounds 85) in all for the treatment, and only three patients had paid more than 1,000 Dkr. during the past three months. Women had paid relatively more for their treatment than men.

[Increased use of resources at psychiatric departments after the introduction of legislation on limitation of liberty and other forms of restriction in psychiatry. A prospective 3-month study]. / Oget ressourceforbrug på psykiatrisk afdeling efter indførelse af lov om frihedsberøvelse og anden tvang i psykiatrien. En prospektiv 3 måneders undersøgelse.

The Danish legislation on restriction of liberty and other forms of compulsion in psychiatry was introduced on 1.10.1989. This legislation has involved an increased workload for psychiatric departments. A prospective investigation during a period of three months in an acute closed admission department in Frederiksberg Hospital revealed, as minimum figures, increased weekly working time for the caring staff of 28 1/2 hours, for doctors 6 1/4 hours and one hour for secretaries. In addition, the department registered an increased bed-day employment resulting from the new legislation. As the department has not received any new resources of note, this time must be taken from the time available for therapeutic work for all of the patients. Unless new resources are awarded to psychiatry, it is to be feared that the general psychiatric service will deteriorate.

[Changes in the function of a psychiatric department during 1983-1988]. / Aendringer i en psykiatrisk modtagelses funktion 1983-1988.

From 18.4.1988 to 17.6.1988, 374 emergency referrals were registered and 495 other referrals to the psychiatric admission department, Frederiksberg Hospital. The two main reasons for the referrals, in both men and women, were alcoholism and/or psychosis. Compared to a similar study from the same period in 1983, the number of emergency referrals was stabilized while the number of other referrals increased by 63%. The majority of the 495 other referrals were chronic psychotic patients and/or addicts who were, as a rule, already under treatment in the day-care hospital or out-patient clinic. Previously, part of this group of patients remained in state mental institutions for long periods. After the change to district psychiatric treatment, the admission department acts as a semi-acute asylum, since suitable resorts outside the psychiatric institution are not available.