2009 issue 3


Volume 18, issue 3

Original paper

Evaluation of forensic psychiatrie opinions in involuntary admission cases

Stanisław Dąbrowski1, Włodzimierz Adam Brodniak1, Wanda Langiewicz1, Stefan Welbel1
1. Zakład Organizacji Ochrony Zdrowia Instytutu Psychiatrii i Neurologii w Warszawie
Postępy Psychiatrii i Neurologii 2009; 18 (3): 235-242
Keywords: forensic psychiatric opinions, coercive treatment, involuntary admission

Objectives. The paper presents results of an evaluation offorensic psychiatric opinions in cases of involuntary hospitalization, either emergency or upon petition for involuntary admission, by the type of diagnosis.
Method. In the study forensicpsychiatric opinions and court files were analyzed for their ąuality using two ąuestionnaires: "Assessm ent offorensic psychiatric opinions" and "Assessment of guardianship court files", considering the mode of involuntary admission. The total of 560 cases were analyzed, in that number 436 were emergency, and 124 non-emergency hospitalizations, the latter by judicial decision upon a petition for involuntary admission. Moreover, an attempt was made to distinguish specific characteristics of cases with delusional and affective psychoses.
Results. Among emergency admissionspersons diagnosed with schizophrenic disordersprevailed (53.2%), in a largeproportion (25.5%) incapable of expressing their consent to admission to a mental hospital. The majority (66.3%) did not consent to their admission to a mental hospital or a psychiatric ward at a general hospital, while 8.2% expressed at admission their consent to hospitalization and treatment. Major irregularities included: a lack of personal examination (11% of the opinions), inadeąuately justified or lacking socialprereąu isites (31% and 37% of cases, respectively). Insufficient or lacking medical justification was noted in 18 and 9% of the opinions analyzed, respectively, while in 73% of cases it was evaluated as good or satisfactory. As regards patients petitioned for involuntary admission, appeals from the judicial decision and an attorney 's participation in the proceedings were noted in only about 1% of cases. In a considerable number of cases the participants (43%) and forensic experts (35%) were absent from the court hearing. The majority (74%) of the proceedings were completed within 12 weeks. The freąuency of returned files, discontinuance of the proceedings, and less often - of dismissing the motion was not higher than 25%. The majority (75%) of proceedings ended with a judicial decision about involuntary hospitalization. A large proportion (45%) of certificates enclosed to petitions had been issued without a personal examination and with no detailed justification for the need for psychiatric inpatient treatment. On the other hand, a majority of expert opinions had been based on a personal assessment, usually performed at the patient's home, or - less often - in an outpatient clinic or hospital (21% and 11%, respectively). Among diagnoses schizophrenic psychoses and paranoid syndromesprevailed (17% and 26% of cases). Medical justification was well-grounded in 41% of cases, satisfactory in 26% and inadeąuate in 14% of cases. In 21% of the opinions there was no justification for the need for treatment.
Conclusions. In emergency admissions social prereąuisites to justify the case were often missing or inadeąuate. Every 9th opinion had been issued with no previous personal assessment. As regards cases petitioned for involuntary admission, a large proportion of the participants (patients) and forensic experts did not participate in the court hearing; returned files and attorney's participation in the proceedings were noted infreąuently. A large number of certificates had been issued without a personal assessment and with no detailed justification for the need for treatment in a mental hospital. Medical justifications were generally well-grounded, irrespective of the mode of proceedings.

Address for correspondence:
Dr Włodzimierz A Brodniak
Pracownia Suicydologiczna ZOOZ
Instytut Psychiatrii i Neurologii
al. Sobieskiego 9, 02-957 Warszawa
e-mail: brodniak@ipin.edu.pl