This week, Mad in America examines four studies related to patient and psychiatrist characteristics and psychiatric detention. The first finds that social marginalization is linked to higher rates of psychiatric detention and worse clinical improvement. The second finds that being male, having lower educational attainment, and single marital status are associated with involuntary admission. The third reports that immigrants and socially disadvantaged people face higher rates of psychiatric detention. The fourth finds that psychiatrists’ characteristics are linked to significant variation in recommending psychiatric detention. Together, these studies suggest that decisions around involuntary admission are not always based on clinical necessity, but significantly influenced by patient and psychiatrist characteristics.
Social Marginalization Is Associated With Higher Rates of Psychiatric Detention and Lower Clinical Improvement
A new Swiss study published in the International Journal of Law and Psychiatry finds that a specific demographic profile, including non-Europeans with low socioeconomic status, high rates of social welfare dependence, and temporary residency, is linked to significantly higher rates of psychiatric detention. This research, led by Jana Carlet from the University of Zurich in Switzerland, also reports that clinical improvement after treatment is significantly lower for this group.
The goal of this study was to assess the rates of involuntary admission among identified subgroups of psychiatric patients and to test the hypothesis that groups experiencing multiple forms of social marginalization are more likely to face psychiatric detention. The authors used clinical data from 16,024 adults admitted as inpatients to the University Clinic Zurich between 2017 and 2020 to examine the link between specific demographic profiles and involuntary admission.
Four subgroups of psychiatric inpatients were identified. Class 1 represented 55.1% of admissions and was predominately Swiss citizens with secondary education and average socioeconomic status. Class 2 represented 23.2% of admissions and included mostly European Union foreign nationals with stable residence and some education. Class 3 accounted for 13.9% of admissions and included young Swiss nationals with lower educational attainment. Class 4 represented 7.8% of admissions and included non-European citizens with low socioeconomic status, high rates of social welfare dependence, temporary residency, low educational attainment, and “insufficient” language skills.
After adjusting for clinical variables including diagnosis and symptom severity, class 4 was at a 49% increased risk of involuntary admission compared to class 1. Classes 2 and 3 had nearly identical odds of involuntary admission compared to class 1. Clinical improvement after treatment was also significantly lower in both classes 3 and 4 compared to class 1. This means the group least likely to be helped by psychiatric treatment was at significantly increased odds of being forced into that treatment against their will.
Male Sex, Lower Education, Single Marital Status, and Psychotic Disorders Are Associated With Greater Risk of Psychiatric Detention
A new Polish study published in the International Journal of Law and Psychiatry finds that certain demographic factors are linked to higher rates of psychiatric detention, including male sex, lack of higher education, and single marital status. This study, led by Andrzej Kiejna from the University of Vocational Education in Poland, also finds that female sex, secondary or higher education, and being single were linked to longer psychiatric hospital stays.
The goal of this research was to identify demographic and clinical factors linked to psychiatric detention and longer stays in psychiatric hospitals. The authors used data from questionnaires, hospital statistics, and demographic information collected from all involuntarily detained patients at the Lower Silesian Centre of Mental Health between 2016 and 2022.
Male sex, lack of higher education, single marital status, and a diagnosis of schizophrenia, other psychotic disorders, and alcohol use disorder were linked to higher odds of psychiatric detention. Female sex, higher education, single marital status, emergency or legally based admission, history of previous psychiatric hospitalization, and schizophrenia diagnosis were all linked to longer lengths of stay.
Immigrants and Socially Disadvantaged Patients Face Higher Odds of Psychiatric Detention
A new Canadian study published in Psychiatric Services finds that demographic factors such as being an immigrant, homelessness, having no income, and lower educational attainment are linked to psychiatric detention. This research, led by Soyeon Kim from McMaster University in Canada, also finds that while immigrants were less likely to face involuntary psychiatric assessment, they were more likely to be detained against their will in a psychiatric facility.
The goal of this research was to investigate whether certain demographic factors were linked to a higher likelihood of psychiatric detention. The authors examined administrative and clinical data from 53,088 people that were detained against their will in a psychiatric hospital in Ontario, Canada.
After adjusting for clinical variables, both recent (37% higher odds) and long-term (51%) immigrants were more likely to face psychiatric detention compared to non-immigrants. Homeless people (87%) and those with no income (43%) also faced increased odds of psychiatric detention. Having some level of university education was linked to 16% lower odds of involuntary admission.
Homeless people (73% higher odds) were more likely to face involuntary psychiatric assessment. Indigenous people had tripled odds of facing involuntary psychiatric assessment, but were not more likely to be involuntarily admitted. Immigrants had lower odds of involuntary assessments (19%), but increased odds of psychiatric detention.
These three previous studies each had three main limitations. The authors used routinely collected administrative and clinical data which lacked some significant details such as reasons for migration, explicit ethnicity, qualitative markers of structural discrimination, and information on qualitative markers of systemic discrimination. The design of the studies means the results cannot speak to causes, only associations. These studies were conducted in specific geographical locations within a small number of inpatient facilities, significantly limiting generalizability to other populations.
Psychiatrist Characteristics Are Linked to Significant Variation in Detention Recommendations
A new US study published in PLOS Mental Health finds that some psychiatrist characteristics, such as location, type of clinical experience, and levels of paternalism, are linked to a higher likelihood of recommending psychiatric detention. This study, led by Karin R. Lavie from the University of Chicago, also reports that psychiatrists’ demographics and overall years of experience were not linked to their likelihood of recommending involuntary admissions.
The goal of this research was to investigate psychiatrist factors that were linked to increased likelihood of recommending psychiatric detention. The authors also wanted to evaluate how psychiatrists’ characteristics were linked to their level of confidence in recommending involuntary admission.
They invited psychiatrists and psychiatry trainees from eight academic departments in the US to participate in an online survey around these questions. Each participant was presented with eight hypothetical psychiatric emergency situations and asked to indicate if they would recommend psychiatric detention or discharge. They also rated their confidence in their decision on a scale from 0 to 100. In total, the authors used data from 246 participants.
There was substantial variation in the recommendation of psychiatric detention between psychiatrists. Overall, 48% of responses to the hypothetical emergency psychiatric situations recommended involuntary admission. The average confidence in those decisions was 68 out of 100.
Psychiatrists and trainees located in the Northeast and Southeast were significantly more likely to recommend psychiatric detention compared to their peers in the Midwest, Southwest, and West. Those that had worked in inpatient settings were also more likely to recommend involuntary admission while participants that had previous experience in a psychiatric emergency service were less likely to recommend the same. Paternalistic attitudes, belief that hospitalization benefited patients, and higher levels of comfort with clinical risk were all linked to higher rates of recommending psychiatric detention. Experience working in emergency situations and higher levels of comfort with clinical risk were both linked to higher confidence in psychiatrists’ and trainees’ decisions.
This study had three main limitations. The design of the study means the data can only speak to associations between psychiatrists’ characteristics and psychiatric detention recommendations, not causes. Only psychiatrists and psychiatric trainees from academic institutions in five US states were included in the current work, limiting generalizability to other populations. The situations were hypothetical and may not truly indicate how participants would respond in an actual emergency situation.
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Carlet, J., Hotzy, F., Maatz, A., Homan, P., & Müller, M. (2026). Analysing risk factors for involuntary admission from an intersectional perspective: A latent class analysis. International Journal of Law and Psychiatry, 105, 102191. (Link)
Kiejna, A., Cichoń, E., Stachów, M., Gondek, T. M., Bukowska, A., & Todzia-Kornaś, A. (2026). Admission without consent to a psychiatric ward and length of hospital stay: The role of selected sociodemographic and clinical factors. International Journal of Law and Psychiatry, 107, 102222. (Link)
Kim, S., MacQuarrie, E., Oh, S., Do, R., Ham, E., Hilton, N. Z., & Fung, K. P. (2026). Social Determinants and trends in involuntary psychiatric detentions: A decade of population-based data. Psychiatric Services, 77(8), 709–717. (Link)
Lavie, K. R., Lee, R., & Jacobson, K. C. (2026). Identifying psychiatrist characteristics associated with likelihood of recommending involuntary hospitalization for patients using a novel tool to assess decision-making. PLOS Mental Health, 3(4). (Link)
It’s a sport. Hunt down the stray baboon youngsters in the holiday season, make a little extra by creating a temporary playground for them (a maze) and allow some “vacant” agressive babboons play trap the little one.
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I think “social marginalization, immigration status, education, sex, and psychiatrists’ own characteristics may determine who is subjected to involuntary psychiatric treatment.” But I don’t believe defaming people with the invalid disorders, and neurotoxic poisoning people with the psychiatric treatments, is of any value to anyone – other than the for-profit only psych workers.
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By using any term like “clinical improvement,” as in Richard’s and therefore MIA’s second sentence in the opening paragraph above, without any qualifying “so-called” before it or “” around it, are not Richard and MIA continuing to endorse the whole mad notion of “mental illness,” and therefore the pathologization and medicalization of our entire human condition – that which is surely the very foundation upon which contemporary coercive psychopharmacology rests and which MIA avowedly wishes to…to what?
MIA at Eight Years: Are We Fulfilling Our Mission? – Mad In America https://share.google/G2Yy6rSp2sJ6CjZZj
Either MIA believes that there can be “mental illness/es” – diseases of the mind, of thinking and emoting and so of behavior – or it does not.
Has it made up its mind on this yet, as I believe Steve McCrae, thankfully, has?
I think MIA might could maybe be clearer about what it thinks, and to behave and blog and endorse accordingly if it wishes to do its utmost to…help us all to think more clearly and, hopefully, even to so elevate our thinking and/or our awareness as to acknowledge that we can all access levels of consciousness from where we may understand that it is our very thinking and our being lost in thought and in emotion which is the issue facing us all?
Bohr reportedly counseled:
“Never express yourself more clearly than you are able to think.” – Niels Bohr – Wikiquote https://share.google/A0IsV7yjXTgxStrND
Jung supposedly advised:
“Who looks outside, dreams; who looks within, awakes.”
Lai Tzu supposedly told:
“At the center of your being you have the answer: You know who you are and you know what you want.”
Eckhart Tolle, I believe, asked what’s the good (or use or point?) of reincarnation if in your next life you still don’t know who you are.
Jesus reportedly told Pharisees: “The Kingdom of God is within you!”
Luke 17:20-21 KJV – And when he was demanded of the – Bible Gateway https://share.google/locayUjEXHInyNEtM
Neale Donald Walsch advised us, I believe, that “It’s not about you!”, that what we seek IS seeking us and that we should be the source – or try to be the source – for others of whatever it is we feel we most lack ourselves.
And Dolly exhorted us to “Find out who y’are, and do it on PURpose,” of course, while Joan of Arc, of whom G.K. Chesterton wrote that she chose her path, and went down it like a thunderbolt,” declared that she was not afraid (of the English/Burgundian soldiers,’ I was born to do this!”
And psychiatrist Viktor Frank, who reminded us that it is all about finding/giving life meaning, suggested that we can all find that by helping others find it..
while Sancho Panza (?1695?) pointed out…”….for we are all as God made us, and many of us much worse”….and Prince Hamlet (?1603?):
“…for there is nothing either good or bad,
But thinking makes it so,”
and Mary Wollstonecraft Shelley (?1790?) that
“No man chooses evil because it is evil; he only mistakes it for happiness, the good he seeks,”
and Socrates ?may have suggested that “Who knows what is right will do what is right,” a sentiment echoed from his cross by one Jesus with his reported “They know not what they do!”
From where and when can anyone ever enter Zen? Always only ever from here and now – right?
If we know this to be true – and, I mean, like, we DO all do know this, deep down, don’t we? – then who needs “antidepressants” or other mind/mood altering drugs (caffeine, btw, is a food group chez moi, by the way)…or to continue to speak of “mental disorders” when the human condition, itself, IS a mental condition – unless and until we are no longer lost in thought, but rediscover the joy of no-mind, of the Kingdom of the Skies/Heavens/Heaven/”God”/”the Father” – or the realm of “emptiness,” “spaciousness ,” or if formless consciousness which is always and ever within each of us as “the light of the world,” or the “I-AM” consciousness which has neither beginning nor end and which, contrary to what male politicians composing bibles in Nicaea or in Pennsylvania or in DSM committee rooms might have us believe and, believing such absurdities, lead us to commit or condone or ignore atrocities?
“The human condition: lost in thought.” – Eckhart Tolle in “Stillness Speaks.”
Bibles have been written by men with inclinations towards power, influence, money, wealth, coercion and corruption.
Insights into our divine human nature have been freely offered us didn’t the ages by women and men such as Dolly Parton and Rumi and Frances and Clare of Assisi, and Meister Eckhart, displaying no such inclinations or egos.
And we STILL don’t get it, do we?!
“Oh, what idiots we all have been. This is just as it must be.” – Niels Bohr.
“I go into the Upanishads to ask questions.” – Niels Bohr.
“What is it that we humans depend on? We depend on our words… Our task is to communicate experience and ideas to others. We must strive continually to extend the scope of our description, but in such a way that our messages do not thereby lose their objective or unambiguous character … We are suspended in language in such a way that we cannot say what is up and what is down. The word “reality” is also a word, a word which we must learn to use correctly.” – Niels Bohr.
“Personality disease,” anyone, please, or would you prefer a “mental disorder?”
Comfort and joy!
Tom.
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Sounds like it isn’t about “clinical need” at all. If they were focused on “clinical need,” they’d clearly avoid detention in any way possible and focus instead on making quality services available. Of course they’d also have to figure out what “quality services” really are, which would mean a complete deconstruction of the current model and starting over from scratch. I won’t be holding my breath…
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The findings presented in this piece – (Psychiatric Detention Isn’t Just About Clinical Need, Four Studies Suggest Research from Switzerland, Poland, Canada, and the US finds that social marginalization, immigration status, education, sex, and psychiatrists’ own characteristics may determine who is subjected to involuntary psychiatric treatment.
By Richard Sears -August 28, 20263
636
This week, Mad in America)
seem to be less than whole and objective.
Psychiatry, involuntary admissions, involuntary treatments, do not stand alone in their own right.
There are Rules, Policies, Standards, Regulations, Laws, and other Legalities involved that supposedly “must” be followed.
Maybe those who are being incarcerated per se, are the most easily targeted, and that happens to be because of their status and standing or rather the assumed lack thereof. The chicken or the egg question.
If it weren’t for such targeted vulnerable people, would the vast majority of institutions of psychiatry cease to exist?
Private institutions and services will take cash payments and or treat (whatever that means) up until the insurance covers costs (usually two weeks). These services seem to be for the educated and or wealthy. Though wealth alone would be sufficient.
Public institutions would be empty if it were not for the mentioned stereotypes and demographics. The prevailing targets are a necessity to keep services, experts, heads of departments, managers, leadership, and other staff employed and salaried, and endear some with titles of note and importance.
Is this truly an interesting and eye-opening and novel finding?
At any given time, the population of psychosis patients could be young females, or first time mothers. Or young prison representatives who have or had substance use issues and who are withdrawing, and or are being drugged as per prison protocols written by expert psychiatrists et al.
These findings are centuries old, are they not?
“Quality Services” are what are presented in black and white that keeps providers out of legal entanglements. The service, services that are actually available and actually provided are in line with the least efforts for maximum financial gains.
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