Preventing Involuntary Admissions: What Works?

To address the desire of regulatory agencies around the world to reduce or eliminate involuntary hospital admissions, Dutch investigators conducted a meta-analysis of 13 randomized, controlled trials (N=2970 patients) of four common interventions.

The interventions were:

• Advance statements, including advance directives and joint crisis plans (JCPs);

• Community treatment orders (outpatient commitment or assisted outpatient treatment [AOT]);

• Compliance-enhancement techniques such as treatment-adherence therapy and financial incentives for adherence to antipsychotic medications; and

• Integrated or enhanced outpatient treatment, involving crisis-resolution teams or psychoeducation with focused monitoring.

The only approach that demonstrated a significa…