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Ethics & Impartiality of Involuntary Hospitalization in Psychiatric Patients


There is a range of situations in which the health care professionals and scholars cannot come to a concrete decision. Such types of situations are termed as “dilemmas” in the language of ethics, which depicts no easy solution. Involuntary hospitalization is also considered one of them by different health scholars. Various terms are used for involuntary hospitalization like involuntary commitment, involuntary admission, detained admission, enforced hospitalization and compulsory admissions etc. Involuntary hospitalization is the hospitalization against the patient’s will. The enforced hospitalization of people with mental health problems has long been a controversial issue and even in few states it assumes in competency and patients lose their civil rights. So, the above given mental picture bestow a depiction that involuntary hospitalization is an unsuccessful line of attack to maintain ethical and moral standards in treatment and care.
Involuntary hospitalization for mentally ill clients has a very profound impact on the patient’s mental health, on family members and the society as well, because this type of admission arises some negative and unconstructive conflicts between the patients and their family members. Patients perceive that they are not treated according to their wishes and needs. In our societies and cultures mentally ill patients are stigmatized for their unpredictable behaviors and they are not given respect, dignity and self-determination in terms of making decision for themselves. . Despite to encourage and treat them, they are demotivated in our societies and cultures. Due to which they make out that they are burden on their families and on the society that leads them to negative emotions and feelings. Therefore, it becomes difficult for them to get adaptation to their issues and concerns.

Every individual has some fundamental and basic rights like right of autonomy, choice of freedom, right to refuse treatment, right to informed consent and right to execute wills. If we will take care of these rights then we can have positive results on behalf of our patients and the patients will also get volunteer admissions in the hospitals. So as health care professionals we should discourage involuntary hospitalization to bring some change in the lives of mentally ill patients.
It is construed that significance of the patient values, beliefs and willingness to treatment has a bottomless effects on his/her mental as well as physical health. If a patient is respected in making his own decisions then he/she will get self-confidence, self-awareness, and high self esteem and will accept that he/she is a loved one for their family members that will force the client to the treatment modalities happily. But there are some factors that can lead to take decision against the patients will in our society and culture that enhance the prevalence of involuntary commitments. These factors include economical problems, unproductive coping, social factors which include social norms and cultural values and availability of treatment modalities. According to a survey even in the developed countries the ratio of involuntary hospitalization is very high. In late fifties, world health organization reported that almost 90% of admissions to state mental hospitals in the United States were involuntary and approximately 10% were voluntary but the trend has shifted to more voluntary admissions currently about 73% because of its constructive and voluntarily promulgate effect in the modern society.

There is a very strong and sturdy relationship of involuntary hospitalization and illness in a way that if an individual is not getting involvement and taking part in his care and treatment and the decision is made against his will. Then certainly his mental health would be affected and he/she may exhibit prominent features of aggression, erratic behaviors, depression, violence, hopelessness, loneliness, stress, mania, personality disorders, and some other devastating mental illnesses. According to Maslow hierarchies needs that if the basic needs of an individual is not fulfilled he/she cannot progress towards self actualization that will again leads to influence and affect his mental health. So if we are neglecting the basic needs and rights of our patients self-determination then how we can achieve optimal outcomes in our care and treatment.
Some of the strategies, which are effective for promoting and enhancing mental health for involuntary admitted clients, are mentioned here. Client and family education and awareness about the client’s illness and behaviors is the key approach towards promoting mental health of the client. By health teaching the family can get a better way to deal their clients in all spheres of treatment and care. Counseling is another effective strategy through which a health care professional and client can explore other types of coping mechanisms e.g. verbalization of feelings to demote the destructive behaviors and emotion and realization of the situations. Another strategy, which is of great importance recently in psychiatry, is the insight therapy. Insight therapy is used to help the patient to identify the causes of his behaviors and to know about his illness and its required treatment. During hospitalization whither it is voluntary or involuntary, keep the clients involve in various activities like intellectual games and puzzles, through which the patients may utilize their critical thinking to explore the consequences towards their treatment. All these things would really assist them that how to deal with the problems and how to take right decision for themselves regarding their health.

In short it will not be out of place to say that involuntary hospitalization is no more acceptable way of treatment in the modern world because it degrades the basic rights of client’s autonomy, freedom of choice, self-respect and values. This type of admission has some scary effects on the client’s mental, intellectual and social health that prevails to more and more mental illnesses. Therefore as a health care professional it is our legal and moral responsibility to give reverence to the client views and decisions and to aware the family members related to those consequences, which can arise during involuntary hospitalization of their clients. This awareness and understanding would probably maintain the ethical standards in our clinical practice. As health practitioners, we can bring improvement in the quality care of the clients and their families in a way if we have competency in care, effective communications to resolve the conflicts and best problem solving skills while working in different settings.

By : Sardar Ali
Lahore