Involuntary commitment in psychiatric care: what drives the decision?

BACKGROUND: Psychiatric commitment laws have been reformed in many European countries. We assessed the relative importance of the different legal criteria in explaining involuntary commitment under the Belgian Mental Health Act of 1990. METHOD: Psychiatric assessments were requested for 346 patients living in Brussels who were randomly selected from a larger group and were being considered for involuntary commitment. A retrospective study of these patients' files was carried out. RESULTS: More than half of the requests for involuntary commitment were turned down. The lack of a less restrictive alternative form of care was the criterion most crucial in decisions in favour of commitment. Alternative forms of care were more likely to be unavailable for psychotic individuals, foreigners, and patients not living in a private household. CONCLUSION: Involuntary commitment is mainly due to the inability of the mental health care system to provide more demanding patients with alternative forms of care