The benefits and harms of inpatient involuntary psychiatric treatment: a scoping review

This scoping review examined quantitative research comparing involuntary inpatient groups with voluntary inpatients or other comparator group. Ten themes were identified: patient knowledge of legal status, experienced or perceived coercion, effects on medication use, clinical effects measured on outcome scales, effects on psychiatric readmission, use of restraints and seclusion, effects on suicide and deaths, patient satisfaction, length of stay and carer experiences. The review found that involuntary inpatient admission was associated with harms including increased subjective and objective coercion, increased cost and decreased patient satisfaction. In addition, it found that there may be significant confusion among both voluntary and involuntary patients regarding their legal rights. However, patients admitted on an involuntary basis experienced greater improvements in symptoms and function, possibly due to greater symptom burden prior to admission. Involuntary treatment carries the potential for both benefit and harms that should be acknowledged and mitigated by service providers.