Should We Try to Avoid Civil Commitments?
Although in general it can be informative to examine aggregated data from a large group of patients to evaluate trends in compulsory admissions (2), more detailed information is needed before one can make policy recommendations. The authors themselves mentioned that patients admitted on a TDO during weekends (when TDOs were longer) may not be the same types of individuals as those admitted on a TDO during regular office hours. Not emphasized by the authors but probably also relevant is that the treatment provided during weekends may not be the same because fewer staff are available. In their discussion, the authors note that longer TDOs can reduce coercion. However, voluntary patients can also feel coerced (3)—for example, when they feel that they are not involved in the admission process (4). Patients might well feel coerced during a TDO and might even feel coerced during a voluntary admission after a TDO. Although the effects of feelings of coercion on future engagement in treatment are not clear (5), there is a lot to be said for trying to reduce experiences of coercion among patients with mental health problems. However, the authors do not provide any information about experiences of coercion, and such information is needed to inform decisions about whether longer TDOs are advisable.
References
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