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BMC Psychiatry. 2019 Apr 29;19(1):127. doi: 10.1186/s12888-019-2096-5.

A retrospective analysis of determinants of involuntary psychiatric in-patient treatment.

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LVR Clinics Cologne (LVR-Klinik Köln), Wilhelm-Griesinger-Strasse 23, 51109, Cologne (Köln), Germany.
LVR Institute for Healthcare Research, Wilhelm-Griesinger-Strasse 23, 51109, Cologne (Köln), Germany.
Current address: St. Agatha Hospital Cologne, Feldgärtenstrasse 97, 50735, Cologne (Köln), Germany.
University of Education Heidelberg, Keplerstrasse 87, 69120, Heidelberg, Germany.
LVR Clinics Cologne (LVR-Klinik Köln), Wilhelm-Griesinger-Strasse 23, 51109, Cologne (Köln), Germany.



The purpose of our study was to identify predictors of a high risk of involuntary psychiatric in-patient treatment.


We carried out a detailed analysis of the 1773 mental health records of all the persons treated as in-patients under the PsychKG NRW (Mental Health Act for the state of North Rhine-Westphalia, Germany) in a metropolitan region of Germany (the City of Cologne) in 2011. 3991 mental health records of voluntary in-patients from the same hospitals served as a control group. We extracted medical, sociodemographic and socioeconomic data from these records. Apart from descriptive statistics, we used a prediction model employing chi-squared automatic interaction detection (CHAID).


Among involuntary patients, organic mental disorders (ICD10: F0) and schizophrenia and other psychotic disorders (ICD10: F2) were overrepresented. Patients treated as in-patients against their will were on average older, they were more often retired and had a migratory background. The Exhaustive CHAID analysis confirmed the main diagnosis to be the strongest predictor of involuntary in-patient psychiatric treatment. Other predictors were the absence of outpatient treatment prior to admission, admission outside of regular service hours and migratory background. The highest risk of involuntary treatment was associated with patients with organic mental disorders (ICD 10: F0) who were married or widowed and patients with non-organic psychotic disorders (ICD10: F2) or mental retardation (ICD10: F7) in combination with a migratory background. Also, referrals from general hospitals were frequently encountered.


We identified modifiable risk factors for involuntary psychiatric in-patient treatment. This implies that preventive measures may be feasible and should be implemented to reduce the rate of involuntary psychiatric in-patient treatment. This may include efforts to establish crisis resolution teams to improve out-patient treatment, train general hospital staff in deescalation techniques, and develop special programs for patients with a migratory background.


CHAID; Coercion; Decision-tree analysis; Involuntary admission; Mental health act

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