[Changes in involuntary admission and compliance with legal criteria 10 years after implementation of the Mental Health Law of the People's Republic of China].

چکیده اصلی

OBJECTIVES: The Mental Health Law of the People's Republic of China (hereinafter referred to as the Mental Health Law), which came into effect in 2013, restricts involuntary admission to specific circumstances in order to protect the rights and interests of individuals with mental disorders. This study aims to evaluate changes in the rate of involuntary admission and compliance with the legal criteria for involuntary admission among patients with mental disorders 10 years after implementation of the law. METHODS: A repeated cross-sectional study design was used. Newly admitted patients were consecutively recruited from the psychiatric wards of the Second Xiangya Hospital, Central South University, over periods of 1 to 2 months in 2012 and 2023, respectively. Sociodemographic and clinical characteristics were collected. Aggressive behavior, social functioning, insight, psychiatric symptoms, and capacity to provide informed consent were quantitatively assessed using the Modified Overt Aggression Scale (MOAS), Social Disability Screening Schedule (SDSS), Insight and Treatment Attitudes Questionnaire (ITAQ), Brief Psychiatric Rating Scale (BPRS), and Semi-Structured Inventory for Competence Assessment (SSICA), respectively. Compliance with the legal criteria for involuntary admission was determined according to the relevant provisions of the Mental Health Law, together with admission diagnoses and scale scores. RESULTS: A total of 618 patients were included. The overall rates of involuntary admission were 34.7% in 2012 and 30.1% in 2023 (P=0.220), while the corresponding rates in closed wards were 53.1% and 47.4% (P=0.264). After adjustment for demographic and clinical characteristics, year was not significantly associated with involuntary admission to closed wards (P=0.375). Among involuntarily admitted patients in closed wards, the proportions who did not meet the legal criteria were 32.9% in 2012 and 44.4% in 2023 (P=0.104). However, after adjustment for demographic characteristics, patients admitted in 2023 were more likely than those admitted in 2012 not to meet the legal criteria (P=0.032). Among involuntarily admitted patients in closed wards, those who met the legal criteria had higher BPRS hostility-suspiciousness factor scores than those who did not (P<0.001), and this association remained significant after adjustment for year (P=0.005). No statistically significant differences were observed between the 2 groups in social functioning, insight, or capacity to provide informed consent (all P>0.05). CONCLUSIONS: Compared with the period before implementation of the Mental Health Law in 2012, the rate of involuntary admission showed no significant change 10 years after implementation in 2023. A substantial proportion of involuntarily admitted patients still did not meet the legal criteria, indicating that a gap remains between the current legal standards and clinical practice and that further efforts are needed to improve their alignment.

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