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Compulsory admission (CA) refers to the process of hospitalization of an individual to a psychiatric ward or hospital, without their consent, due to severe mental health conditions. While it is an established and legally framed practice in many countries, it raises a number of ethical issues in terms of personal liberty and risks of potential misuse. Ethnicity, male gender and psychosis are the main risk factors for compulsory admission to psychiatric wards/hospitals in general population. Previous studies documented that CA is even more frequently used in prison, yet its determinants are still unknown. To address this issue, we explored the clinical, demographic and criminological determinants of compulsory admission in 317 detainees admitted to a psychiatric acute care secure ward located in the central prison of Geneva. We distinguished three groups: voluntary admissions only (VA), CA only and mixed admissions (MA). Judicial status and types of offenses were also recorded. Sociodemographic data included age, gender, and origin. Clinical parameters included previous compulsory admissions, previous hospital stays, number of admissions, length of stay, number of suicide attempts, short-term seclusions and ICD-10 clinical diagnoses. Fisher’s exact, Chi 2 and Kruskal Wallis tests were used for group comparisons. Logistic regression analysis was used to explore the association between the legal status of hospital stays and clinical diagnosis. There was no significant difference between the three groups in respect to sociodemographic factors. Past compulsory admissions were significantly more frequent in the CA compared to the VA group. Both the mean number of admissions and length of stay differed significantly between the three groups. The number of suicidal attempts was significantly higher in MA compared to both VA and CA groups. Short-term seclusion was significantly more frequent in CA and MA compared to VA. Psychotic disorders were much more frequent in CA (55.1%) and MA (54.8%) compared to VA cases (23.9%). In contrast, depressive and anxiety disorders were significantly less frequent in CA (12.3%) and MA (14.3%) than VA (29.5%). Of importance, neither the type of offenses nor the judicial status differed between the three groups. In regression models, CA was strongly and positively associated with psychotic disorders. The inverse was true for depressive, anxiety as well as adjustment disorders. The present findings reveal that, in contrast to the general population, sociodemographic factors have no impact on the frequency of CA in a population of detainees. The main risk factors for the adoption of this measure are past CA and presence of acute psychosis. In contrast, the presence of depressive and anxiety symptoms limits the recourse to this disputed measure.

Criminological and sociodemographic variables, such as previous criminal convictions, increased risk of violence, early onset of mental disorder, antisocial personality, psychosis and low social support, have all been related to longer length of stay (LoS) and poorer outcome in long stay forensic services. The factors impacting on LoS and clinical response in acute care specialized units are poorly documented. To address this issue, we examined the psychiatric records of all cases admitted between January 1st and December 31th 2020 in the sole acute ward for detained persons located in the central prison of the Geneva County, Switzerland. Information on judicial status included pre-trial versus sentence execution, previous incarcerations, and age of the first incarceration. Sociodemographic data included age, gender, marital status, and education attainment. Previous inpatient stays prior to incarceration were recorded. All of the ICD-10 clinical diagnoses were made by two independent, board-certified psychiatrists blind to the scope of the study. The standardized assessment was based on the HoNOS (Health of Nation Outcome Scales) at admission and discharge, HONOS-secure at admission, HCR-20 (Historical Clinical Risk 20) version 2, PCL-R (Psychopathy Checklist Revised), and SAPROF (Structured Assessment of Protective Factors). Stepwise forward multiple linear regression models predicting the LoS and delta HONOS respectively were built with the above mentioned parameters. The selected variables were then used in univariate and multivariable regression models. Higher HCR-scores (mainly on clinical items), and longer LoS were related to higher delta HONOS scores. In contrast, cases in pre-trial detention showed a worst clinical outcome. In multivariable models, all three variables remained independent predictors of the clinical outcome and explained 30.7% of its variance. Only education and diagnosis of borderline personality were related to the LoS and explained 12.6% of its variance in multivariable models. Our results suggest that the use of acute wards specialized in forensic psychiatry are mainly useful for patients with prior inpatient care experience, and higher violence risk during sentence execution. In contrast, they seem to be less performant for persons in pre-trial detention that could benefit from less restrictive clinical settings.

This article aims to develop and experimentally validate a psychodiagnostic program for persons deprived of liberty, which provides clear directions for recommending psychosocial programs so as to ensure that positive behavioral changes are observed after completing them. Furthermore, this study focuses on highlighting the importance of developing a psychodiagnostic program for incarcerated people to establish more effective methods of intervention and inclusion in various psychosocial programs that contribute effectively to their behavioral change.