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In mental health and psychiatric care, the use of involuntary psychiatric treatment for people with mental disorders is still a central and contentious issue. The main objective of this scoping review was to map and systematize the literature on ethical issues in clinical decision-making about involuntary psychiatric treatment. Five databases (Embase, PsycINFO, CINAHL, Medline, and Scopus) were searched for articles on this topic. Out of a total of 342 articles found, 35 studies from 14 countries were included based on the selection criteria. The articles were analyzed using the inductive content analysis approach. The following main categories were identified: (1) ethical foundations that guide clinical decision-making; (2) criteria for involuntary psychiatric treatment; (3) gaps, barriers, and risks associated with involuntary psychiatric treatment; (4) strategies used to reduce, replace, and improve the negative impact of involuntary treatment; and (5) evidence-based recommendations. Most of the selected articles discuss the logic underlying involuntary treatment of the mentally ill, exploring ethical principles such as autonomy, beneficence, non-maleficence, or justice, as well as how these should be properly balanced. During the process of involuntary psychiatric admission, there was a notable absence of effective communication and a significant power imbalance that disenfranchised those seeking services. This disparity was further intensified by professionals who often use coercive measures without a clear decision-making rationale and by family members who strongly depend on hospital admission. Due to the pluralistic and polarized nature of opinions regarding legal capacity and the complexity and nuance of involuntary admission, further studies should be context-specific and based on co-production and participatory research.

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This month's issue of BJPsych International focuses on psychiatry in Sri Lanka, with articles on suggested improvements in education and training, the country's outdated legislation regarding involuntary psychiatric treatment, and the misuse of prescription medications.

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The Mental Health Act (1996) is legislation that directs voluntary and involuntary psychiatric treatment for people experiencing mental health issues in British Columbia (BC), Canada. This critical discursive analysis explores how BC's Mental Health Act (1996) and the Guide to the Mental Health Act (2005) structure involuntary psychiatric treatment and illustrates how the discourses within these texts constitute people experiencing mental health issues as passive recipients of care. Understandings of people experiencing mental health issues as pathological, incapable, vulnerable and dangerous justify their need for protection and the protection of others. Protection is identified as a central legitimising discourse in the use of involuntary psychiatric treatment. Further, these texts define the roles and responsibilities of police, physicians and nurses in authorising and implementing involuntary psychiatric treatment. This analysis describes how this legislation erodes consent and entrenches social marginalisation. Alternatively, discourses of equity have potential to transform health care practices and structures that reproduce discourses of deficit, vulnerability and dangerousness, shifting towards promotion of the rights and safety of people experiencing mental health issues and crises.

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A dificuldade em demarcar um termo que designe o movimento indicado no título deste artigo é uma demonstração da heterogeneidade que o caracteriza: consumidores, ex-pacientes, sobreviventes da Psiquiatria são algumas das denominações utilizadas pelos grupos que se organizam em torno da advocacy pelos direitos das pessoas que são submetidas a tratamentos psiquiátricos (incluindo o direito de recusa a esses tratamentos) e da construção de redes de autoajuda, pensadas como alternativas ao sistema de Saúde Mental, no contexto dos Estados Unidos. Convido o leitor a conhecer um pouco dessa história por meio do roteiro de um documentário, que não foi e não será gravado, mas que é virtualmente narrado neste texto com a intenção de situar a atuação desse movimento e propor uma discussão teórica que o articule com os conceitos de ativismo biossocial e biodeserção.(AU)

The difficulty defining a term to describe the movement indicated in the title of this article illustrates its heterogeneity: users, ex-patients, and survivors of Psychiatry are some of the names used by the groups who advocate for the rights of people undergoing psychiatric treatment (including the right to refuse treatment) and the creation of self-help networks, designed to be an alternative to the Mental Health system in the context of the United States. I invite the reader to understand a little about the history of this movement using the script of a documentary that has not and will never be recorded, but is narrated virtually in this text with the intention of situating the movement's role and proposing a theoretical discussion that articulates the concepts of biosocial and biodesertion activism.(AU)

La dificultad de demarcar un término que designe el movimiento indicado en el título de ese artículo es una demostración de la heterogeneidad que lo caracteriza: consumidores, expacientes, sobrevivientes de la Psiquiatría son algunas de las denominaciones utilizadas por los grupos que se organizan alrededor de la advocacy por los derechos de las personas sometidas a tratamientos psiquiátricos (incluyendo el derecho de rechazarlos) y de la construcción de redes de auto-ayuda pensadas como alternativas para el sistema de Salud Mental, en el contexto de Estados Unidos. Invito al lector a conocer un poco de esa historia por medio del guion de un documental que no fue ni será grabado, pero que se narra virtualmente en este texto con la intención de situar la actuación de ese movimiento y proponer una discusión teórica que lo articule con los conceptos de activismo biosocial y biodeserción.(AU)

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BACKGROUND: Immigrants in Europe appear to be at higher risk of psychiatric coercive interventions. Involuntary psychiatric hospitalization poses significant ethical and clinical challenges. Nonetheless, reasons for migration and other risk factors for involuntary treatment were rarely addressed in previous studies. The aims of this study are to clarify whether immigrant patients with acute mental disorders are at higher risk to be involuntarily admitted to hospital and to explore clinical and migratory factors associated with involuntary treatment. METHODS: In this cross-sectional matched sample study, we compared the rates of involuntary treatment in a sample of first-generation immigrants admitted in a Psychiatric Intensive Care Unit of a large metropolitan academic hospital to their age-, gender-, and psychiatric diagnosis-matched native counterparts. Clinical, sociodemographic, and migratory variables were collected. The Brief Psychiatric Rating Scale-expanded (BPRS-E) and the Clinical Global Impression-Severity (CGI-S) scale were administered. McNemar test was used for paired categorical variables and a binary logistic regression analysis was performed. RESULTS: A total of 234 patients were included in the analysis. Involuntary treatment rates were significantly higher in immigrants as compared to their matched natives (32% vs. 24% respectively; p < .001). Among immigrants, involuntary hospitalization was found to be more frequent in those patients whose length of stay in Italy was less than 2 years (OR = 4.2, 95% CI [1.4-12.7]). CONCLUSION: Recently arrived immigrants appear to be at higher risk of involuntary admission. Since coercive interventions can be traumatic and negatively affect outcomes, strategies to prevent this phenomenon are needed.

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BACKGROUND: Identifying which factors contribute to involuntary psychiatric hospitalization may support initiatives to reduce its frequency. This study examines the sociodemographic, clinical, and contextual factors associated with involuntary hospitalization of patients from five Portuguese psychiatric departments in 2002, 2007 and 2012. METHODS: Data from all admissions were extracted from clinical files. A Poisson generalized linear model estimated the association between the number of involuntary hospitalizations per patient in one year and sociodemographic, clinical, and contextual factors. RESULTS: An increment of involuntary hospitalizations was associated with male gender [exp([Formula: see text]) = 1.31; 95%CI 1.06-1.62, p < 0.05], having secondary and higher education [exp([Formula: see text]) = 1.45; 95%CI 1.05-2.01, p < 0.05, and exp([Formula: see text]) = 1.89; 95%CI 1.38-2.60, p < 0.001, respectively], a psychiatric diagnosis of psychosis [exp([Formula: see text]) = 2.02; 95%CI 1.59-2.59, p < 0.001], and being admitted in 2007 and in 2012 [exp([Formula: see text]) = 1.61; 95%CI 1.21-2.16, p < 0.01, and exp([Formula: see text]) = 1.73; 95%CI 1.31-2.32, p < 0.001, respectively]. A decrease in involuntary hospitalizations was associated with being married/cohabitating [exp([Formula: see text]) = 0.74; 95%CI 0.56-0.99, p < 0.05], having experienced a suicide attempt [exp([Formula: see text]) = 0.26; 95%CI 0.15-0.42, p < 0.001], and belonging to the catchment area of three of the psychiatric services evaluated [exp([Formula: see text]) = 0.65; 95%CI 0.49-0.86, p < 0.01, exp([Formula: see text]) = 0.67; 95%CI 0.49-0.90, p < 0.01, and exp([Formula: see text]) = 0.67; 95%CI 0.46-0.96, p < 0.05 for Hospital de Magalhães Lemos, Centro Hospitalar Psiquiátrico de Lisboa and Unidade Local de Saúde do Baixo Alentejo, respectively]. CONCLUSIONS: The findings suggest that involuntary psychiatric hospitalizations in Portugal are associated with several sociodemographic, clinical, and contextual factors. This information may help identify high-risk patients and inform the development of better-targeted preventive interventions to reduce these hospitalizations.

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ABSTRACT Objective: to outline the profile and understand the expectations and needs of family members who seek compulsory hospitalization for drug-using members. Method: Mixed research; data collected involving 101 medical records and semi-structured interviews with 26 family members. SPSS software and content analysis was used. Results: The sample was characterized predominantly by women. Most users had other treatment modalities. Significant associations were observed between the request for hospitalization, the presence of aggressiveness, and other behaviors typical of harmful drug use for requesting compulsory hospitalization. The categories were: The difficult coexistence with the user; the journey of family members to "bring the user back to life"; Expectations and needs regarding compulsory hospitalization. Conclusion: The study provided a broader view of the complexity and inter-subjectivities of family systems in the face of the drug cycle, promoting discussions and strategies for multidisciplinary services in the comprehensive care of these families.

RESUMEN Objetivo: Delinear perfil y comprender expectativas y necesidades de familiares que buscan internación forzada para miembros usuarios de drogas. Método: Investigación combinada; datos recogidos envolviendo 101 prontuarios y entrevistas semiestructuradas con 26 familiares. Utilizó el software SPSS y el análisis de contenido. Resultados: Muestra caracterizada predominantemente por mujeres. Mayoría de los usuarios realizó otras modalidades de tratamiento. Observaron asociaciones significantes entre la solicitud de la internación, la presencia de agresividad y otros comportamientos típicos del uso nocivo de drogas para solicitud de internación forzada. Las categorías fueron: La difícil convivencia con el usuario; El trayecto de los familiares para "traer el usuario de vuelta a vida"; Expectativas y necesidades cuanto a la internación forzada. Conclusión Estudio proporcionó la ampliación del mirar a la complejidad e intersubjetividad de sistemas familiares delante al ciclo de las drogas, promoción de discusiones y estrategias de servicios multidisciplinares en el cuidado integral de esas familias.

RESUMO Objetivo: Delinear o perfil e compreender expectativas e necessidades de familiares que buscam internação compulsória para membros usuários de drogas. Método: Pesquisa mista; dados coletados envolvendo 101 prontuários e entrevistas semiestruturadas com 26 familiares. Utilizou-se o software SPSS e a análise de conteúdo. Resultados: A amostra caracterizou-se predominantemente por mulheres. A maioria dos usuários realizou outras modalidades de tratamento. Observaram-se associações significantes entre a solicitação da internação, a presença de agressividade e outros comportamentos típicos do uso nocivo de drogas para pedido de internação compulsória. As categorias foram: A difícil convivência com o usuário; O percurso dos familiares para "trazer o usuário de volta à vida"; Expectativas e necessidades quanto à internação compulsória. Conclusão: O estudo proporcionou a ampliação do olhar para a complexidade e intersubjetividades de sistemas familiares diante do ciclo das drogas, promoção de discussões e estratégias de serviços multidisciplinares no cuidado integral dessas famílias.

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OBJECTIVES: The variable and changing rates of use of involuntary community treatment orders (CTOs) in the treatment of people living with mental illness are not well-documented or well understood. This new study sought to determine contemporary rates of use in Australia, where local jurisdictions were previously shown to have varied and shifting rates of use that were high by world standards. METHODS: Australian state and territory mental health review tribunals, health departments, and/or offices of the chief psychiatrist were surveyed for the most recent published annual data on the total number of individual people placed on a CTO and/or the total number of CTOs made. FINDINGS: Contemporary rates of CTO use in Australia range from 40.0 per 100,000 population (in Western Australia) to 112.5 per 100,000 (in South Australia). Since the last national survey, the rates of people subject to CTOs fell into in two jurisdictions (Victoria and Western Australia). However, rates of CTOs made were higher than previous figures in all jurisdictions reporting data. Use of CTOs in Australia varies considerably within and between jurisdictions. CONCLUSIONS: Australian jurisdictions continue to use CTOs at high and varying rates, despite unresolved questions about their role and impact. Transparency and accountability around their use would be improved by regular and nationally uniform public reporting of CTO data. Further research into how and why CTOs are used may also provide opportunities to respond to factors driving their use and thereby reduce the use of coercion in mental health care.

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