Use of the Mental Health Act criteria in the decision-making process for compulsory admissions: A study of psychiatrists in South London

This study investigates the decision-making process for admitting patients compulsorily under the Mental Health Act 1983 of England and Wales. We used three case-vignettes describing different clinical situations: 1) a man wi th depression and psychotic symptoms; 2) a woman with a possible first epis ode of psychosis; and 3) a man with a history of substance abuse and bipola r disorder. The vignettes were administered to a group of psychiatrists wor king at the Bethlem Royal and Maudsley Hospitals in South London. The psychiatrists were asked to rate 11 factors from the most to the least important in their decision to admit the individual compulsorily. Three fac tors resembled the criteria considered in the Mental Health Act 1983 for co mpulsory admission: current mental state; severity of the disease; and dang erousness to self or others. Three were other clinical features of the pati ent: diagnosis; psychiatric history; and likely response of the mental stat e to the medical treatment. The remaining five were sociodemographic featur es of the patient: age and gender; owning a home; occupational status; and social support available. The psychiatrists were not given the option that the patient would accept a voluntary admission to hospital. We obtained res ponses from 42 psychiatrists (25 males and 17 females). The most important factor for deciding to detain a patient compulsorily was perceived dangerou sness to self and others. The current mental state of the patient and the s everity of the illness were the next two important factors. Our results con firm that the criteria recommended by the Mental Health Act 1983 of England and Wales were applied consistently in three different hypothetical situat ions. The need for protection of the patient or others may take precedence over the current mental state of the patient or the severity of the illness , a finding that warrants further investigation in view of the current deba te on the responsibility of psychiatrists in deciding to detain subjects af fected by personality disorder.