Nearly 25% of child and adolescent admissions to psychiatric hospitals are ‘involuntary’

Nearly one quarter of child and adolescent admissions to psychiatric hospitals are involuntary, a new study suggests.

Researchers also found young black people were almost three times as likely as young white people to be admitted to a psychiatric hospital against their will.

However, they say the reasons for these differences remain unclear.

Experts analysed social and clinical factors associated with psychiatric hospital admission of children and adolescents, and found that 23.6% were admitted to hospital without their consent under mental health legislation.

The study suggests patients involuntarily admitted to psychiatric hospital were more likely to have a diagnosis of psychosis, substance misuse, or intellectual disability than those admitted voluntarily.

The over-representation of certain socio-demographic groups may reflect a cycle of inequality established in childhood that continues into adulthood, researchers indicate.

Lead author Dr Susan Walker (pictured), from UCL, said: “Although involuntary hospitalisation is designed to offer protection to those who are temporarily unable to look after and make decisions for themselves due to the presence of a mental disorder, being admitted against one’s will can be a traumatic experience at any age.

“The number of children and adolescents being admitted to hospital involuntarily is growing in some countries, including the UK, but research into the factors associated with involuntary hospitalisation among young people is surprisingly limited.

“Understanding why some people may be more likely to be admitted without their consent is key to understanding how we can reduce the numbers of involuntary admissions.”

The review identified 23 studies that included information on whether children and adolescents were admitted to hospital voluntarily or involuntarily.

The studies were from 11 high-income countries, including the UK, representing 41,271 young inpatients (with an average age of 18) in total.

Researchers looked at data from 19 studies (31,212 participants) to assess the association with 10 clinical and social factors – gender, primary diagnosis, intellectual disability, ethnicity, living arrangements, risk to self, risk to others, previous abuse, previous psychiatric hospitalisation and age.

They found that for young people with psychosis – when people lose some contact with reality – the odds of an involuntary rather than voluntary admission were more than three times higher than for those without psychosis.

Diagnosis of anxiety was associated with voluntary rather than involuntary admission to hospital, as was a diagnosis of behavioural problems such as ADHD and conduct disorder.

For young people with a primary diagnosis of substance misuse, the odds of an involuntarily rather than voluntary admission were nearly twice as high.

Researchers say that when it comes to children and young people, the distinction between voluntary and involuntary hospital admission is not always clear.

For example, children and adolescents can be admitted to hospital under parental consent and, even if the young person does not agree, this admission would legally be considered voluntary.

The study, published in The Lancet Child and Adolescent Health, found that a diagnosis of intellectual disability increased the odds of an involuntary rather than voluntary admission by more than three times.

Intellectual disability was included in the analysis whether it was a comorbid or primary diagnosis.

In UK mental health law, intellectual disability is not classified as a mental disorder so someone cannot be admitted to hospital involuntarily with a diagnosis of intellectual disability alone.

The experts say psychiatric hospital admission, whether involuntary or voluntary, is rarely appropriate for young people with intellectual disability.

Young people perceived to be at risk to themselves or others were twice as likely to be involuntarily than voluntarily admitted, the research suggests.

It found no association between gender and involuntary admission to hospital in children and adolescents.

According to the study, older adolescents (16-17-year-olds) were more likely to have been subject to involuntary admission than younger adolescents (aged 12-15).

Three of the studies included ethnicity in their research, and analysis of these found the odds of involuntary rather than voluntary admission to psychiatric hospital among children and young people from black ethnic groups were nearly twice as high (172%) as for those from white ethnic groups.

No difference was found between young people from Asian and other groups compared with young people from white groups.

Dr Walker said: “By providing insight into the factors associated with involuntary hospitalisation, our study represents an important step in reducing coercive psychiatric admissions and ensuring equity of care.”

The researchers acknowledge a number of limitations to their study, including limited research in this area, and that the review looked at studies from different countries with different legal criteria for involuntary hospital admission, alongside different mental health systems and processes.

Another limitation is that the studies are all from high-income countries, highlighting the lack of data from low and middle-income countries.

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