Controversy over forced psychiatric admissions: Health clarifies that they will continue to be carried out

BarcelonaSometimes, when a person with a serious mental health problem has a crisis, the professionals attending to them hospitalize them against their will to stabilize them and avoid any harm both to themselves and to those around them. This is what is known as an involuntary or forced admission. This Friday, however, a new law comes into force that aims to strengthen the rights of these patients and increases their protection in various scenarios, such as in this type of hospitalization. The new rule has caused an uproar among the state's scientific societies of psychiatry, which this week have raised an outcry because the law determines that these admissions can only be made when there is a vital emergency. Nevertheless, the Ministry of Health has already clarified that they will continue to be carried out when necessary.

This is the new general disability law, which establishes that any health or care intervention in mental health requires the free and informed consent of the patient. In the event that a professional concludes that it is necessary to impose a measure against their will, such as a forced admission, the regulations restrict them to a vital emergency, that is, if there is a threat to the life or integrity of the person or third parties. For the Spanish Society of Clinical Psychiatry (SEPC), this causes "legal uncertainty" for the professionals who treat these people, and the Spanish Society of Psychiatry and Mental Health (SEPSM) believes that patients and their families are being put at risk.

The societies explain that serious mental illness, when there is a crisis, often prevents the patient from recognizing that they are ill. There are situations that require an involuntary admission, such as psychosis with total abandonment of self-care, a manic episode with serious economic or social damage, cognitive deterioration with erratic behavior, or high-risk suicidal ideation without an immediate plan. The new rule establishes that care for patients with mental health problems must be based on free and informed consent, respecting their wishes, will, and preferences. According to the Spanish government, this reform "guarantees the rights of patients regarding involuntary interventions in mental health".

Judicial order

In the case of involuntary admissions, regulated by article 763 of the Civil Procedure Act, the new rule establishes the scenarios that allow for admission due to vital urgency. However, the SEPSM questions the rule because, when admission is not possible, the responsibility for care is transferred to the home and it is the families who must take charge of these patients, who may have serious crises that put both their health and that of those around them at risk.

From the Health Department, however, they assure that involuntary admissions will still be able to be carried out. "Those that are not urgent will be channeled through a judicial order and those that are urgent will have to conform to the guarantees of the new law," clarified the Mental Health Commissioner, Belén González. The new rule establishes that, in the event that the patient cannot decide, their advance directive must be consulted through registered documents or information collected in their clinical history.

Before hospitalizing someone against their will, the ministry states that voluntary alternatives must have been exhausted, advance directives must have been consulted, necessary supports must have been provided, and accessible information must have been offered to the patient. Physical restraints or mechanical containment will only be considered in exceptional situations and must be treated as an incident related to patient safety, in addition to being documented in the clinical history and subsequently evaluated.