Explaining differences in involuntary admission practice between German federal states

Background: Involuntary psychiatric admissions rates in Germany are among the highest in the western world and they are continuously increasing during the last decade. However, involuntary admissions rates indicate significant differences between German federal states which can neither be explained by differences in the prevalence of mental disorders nor by different legal bases.

Aims: To examine differences in involuntary admission practices between German federal states from the perspectives of psychiatric staff members and the patients. Methods: For a period of three months, all cases of involuntary admission to five psychiatric hospitals in three federal states were systematically documented. Patient recruitment and data collection were performed by the same researcher on a rotation basis during 15 months. Patients’ views of involuntary admission were assessed by means of standardised questionnaires and open patient interviews in order to describe the admission process and appreciate the patient perspective of the admission experience.

Results: Study results indicate that the patients’ perception of the reasons and the specific occasions of involuntary admissions differed from the clinicians’ perception. However, no differences occurred between cases from different federal states. Nevertheless, differences in the distribution of diagnoses and the assessment of patients’ dangerousness indicate a variance in the selection process at the level of persons and institutions who initiated the admission process.