Psychiatric treatment after a civil commitment
background The number of civil commitment proceedings in the Netherlands has increased markedly since 1992. In Amsterdam there has actually been a threefold increase in commitments. This has meant a heavier workload for the Public Mental Health Care Services, the psychiatric clinics, the police, the mayor and the law-courts. Most people seem to be of the opinion that a civil commitment can revitalise psychiatric treatment that has all but failed. This view, however, has not been evaluated scientifically.
aim To conduct a retrospective study of a cohort of committed patients in order to obtain an answer to the following question: does admission to a clinic following a commitment proceeding's order lead to psychiatric treatment?
method From the files of 100 committed patients referred by the crisis team of the Mentrum Mental Health Service, 73 were selected for study; each of these contained a note discharging the patient from the clinic. The following data were noted: diagnosis, length of stay, the way in which the period of commitment was terminated, follow-up treatment when the commitment period ended, and the medication prescribed to the patient during his/her stay at the clinic.
results At the end of the period of commitment the patients fell into three groups: (1) those discharged and immediately leaving; (2) those staying on, voluntarily; and (3) those staying on, compulsorily. It is not clear whether those in group (1) started to receive psychiatric treatment upon discharge. With regard to the other two groups it is known that 75% of group (2) and 84% of group (3) had started to take medication during their stay at the clinic.
conclusion There are indications that 50-60% of the patients resumed or started psychiatric treatment as a result of the commitment. Data are inadequate for conclusions to be drawn concerning 40% of the cohort. Prospective research is needed in order to find out to what extent commitment proceedings actually lead to successful treatment.