Voluntary and involuntary care: three-year study of demographic and diagnostic admission statistics at an inner-city adult psychiatry unit.

Individuals with mental disorders can, under specific circumstances, be detained and treated against their wishes. In 2009, there were 1633 involuntary admissions in Ireland, accounting for 8.1% of all psychiatric admissions. We examined demographic and diagnostic factors associated with involuntary admission in a general adult psychiatry service in Dublin's north inner-city over a retrospective three-year period. The overall admission rate was 450.5 admissions per 100,000 population per year (deprivation-adjusted rate: 345.7), which is lower than the national rate (476.3). The involuntary admission rate was 67.7 (deprivation-adjusted rate: 51.9), which is higher than the national rate (38.5). Fifteen per cent of admissions were involuntary (for all or part of the admission), which is higher than the national proportion (8.1%) but the same as that reported in another inner-city psychiatry service (15.7%). The proportion of admissions that was involuntary was higher amongst individuals from outside Ireland (33.9%) compared to those from Ireland (12.0%) (p<0.001). Country of origin was, however, related to diagnosis: 53.2% of admissions of individuals from outside Ireland were with schizophrenia, compared to 18.5% of admissions of individuals from Ireland (p<0.001). Diagnosis was, in turn, related to admission status: 37.5% of admissions with schizophrenia were involuntary compared to 15% overall (p<0.001). On multi-variable testing, diagnosis was the only independent predictor of admission status (p=0.01) (R(2)=35.2%); country of origin was not an independent predictor of admission status. Deprivation accounts for part, but not all, of the high rate of involuntary admission in Dublin's inner-city. Diagnosis accounts for one third of the variance in admission status between individuals. Further study is required to determine what factors account for the remaining two thirds (e.g. symptoms, insight) and to clarify better the relationships between admission status, diagnosis and country of origin. There is a strong need for enhanced focus on the mental health needs of individuals from outside of Ireland, especially in Dublin's north inner-city.