Hostname: page-component-848d4c4894-pjpqr Total loading time: 0 Render date: 2024-06-25T09:52:48.650Z Has data issue: false hasContentIssue false

Involuntary medication in psychiatric inpatient treatment

Published online by Cambridge University Press:  16 April 2020

R. Kaltiala-Heino
Psychiatric Treatment and Research Unit for Adolescent Intensive Care, Tampere University hospital, 33380Pitkaniemi, Finland
M. Välimäki
Department of Nursing Science, University of Tampere, Medisiinarinkatu 3, 33014, Finland
J. Korkeila*
Department of Psychiatry, University of Turku, Turku University Central Hospital, Kunnallissairaalantie 20, 20700Turku, Finland
C. Tuohimäki
Department of Psychiatry, University of Oulu, PL2G, 90029 OYS, Oulu, Finland
V. Lehtinen
National Centre for Research and Development in Health and Welfare, Turku, Finland
*Corresponding author. E-mail address: (J. Korkeila).
Get access


The aim of this study was to examine involuntary medication in psychiatric inpatient treatment. A retrospective chart review of 1543 consecutive admissions of working aged civil patients from well-defined catchment areas to three psychiatric centres were evaluated regarding events of involuntary medication. 8.2% of the admissions included involuntary medication episode(s). Involuntary medication was associated with a diagnosis of schizophrenia, involuntary legal status and having previously been committed. One of the studied centres used less involuntary medication than the other two, even if patients with schizophrenia were over-represented in that centre. Although involuntary medication mainly takes places in the treatment of patients who are conceptualised most ill and perhaps resist treatment most, treatment culture obviously also plays a role. In future, it is important to study the aspects of treatment culture to fully understand the use of involuntary medication in psychiatry.

Original article
Copyright © Éditions scientifiques et médicales Elsevier SAS 2003

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)


Appelbaum, PSThe right to refuse treatment with antipsychotic medications: retrospect and prospect. Am J Psychiatry 1988;145:413-9.Google ScholarPubMed
Hoge, SK, Appelbaum, PS, Lawlor, T, Beck, JC, Litman, R, Greer, A, et al. A prospective multi-center study of patients’ refusal of antipsychotic medication. Arch Gen Psychiatry 1990;47:949-56.CrossRefGoogle Scholar
Poulsen, HD, Munk-Jörgensen, P, Aggernaes, KHLov om frihedsberövelse og anden tvang i psykiatrien. Ugeskrift laeger 1996;158:5303-7.Google Scholar
Kaltiala-Heino, R, Korkeila, J, Tuohimäki, C, Protshenko, J, Lehtinen, V, Tuori, TCoercion and restrictions in psychiatric inpatient treatment. Eur Psychiatry 2000;15:213-9.CrossRefGoogle ScholarPubMed
Greenberg, WM, Moore-Duncan, L, Herron, RPatients’ Attitudes toward having been forcibly medicated. Bull Am Acad Psychiatry Law 1996;24:513-24.Google ScholarPubMed
Baldessarini, RJEnhancing treatment with psychotropic medicines. Bull Menninger Clin 1994;58:224-41.Google ScholarPubMed
Geiselmann, BInformed refusal: the patient’s influence on long-term treatment. Pharmacopsychiatry 1994;27(Suppl 1):58-62.CrossRefGoogle ScholarPubMed
Binder, R, McNiel, DInvoluntary patients' right to refuse medication: impact of the Riese decision on a California inpatient unit. Bull Am Acad Psychiatry Law 1991;19:351-7.Google ScholarPubMed
Kasper, JA, Hoge, SK, Feucht-Haviar, T, Cortina, J, Cohen, BProspective study of patients’ refusal of antipsychotic medication under a physician disrcretion review procedure. Am J Psychiatry 1997;154:483-9.Google Scholar
Levin, S, Brekke, J, Thomas, PA controlled comparison of involuntarily hospitalized medication refusers and acceptors. Bull Am Acad Psychiatry Law 1991;19:161-71.Google ScholarPubMed
Cournos, F, McKinnon, K, Stanley, BOutcome of involuntary medication in a state hospital system. Am J Psychiatry 1991;148:489-94.Google Scholar
Amarasingham, LRSocial and cultural perspectives on medication refusal. Am J Psychiatry 1980;137:353-8.Google ScholarPubMed
Ford, MThe psychiatrist’s double bind: the right to refuse medication. Am J Psychiatry 1980;137:332-9.Google ScholarPubMed
Hermann, DAutonomy, self-determination, her right of involuntarily committed persons to refuse treatment, and the use of substituted judgement in medication decisions involving incompetent persons. Int J Law Psychiatry 1990;13:361-85.CrossRefGoogle Scholar
Appelbaum, P, Gutheil, TDrug refusal: a study of psychiatric inpatients. Am J Psychiatry 1980;137:340-6.Google ScholarPubMed
Hoyer, G, Kjellin, L, Engberg, M, Kaltiala-Heino, R, Nilstun, T, Sigurjonsdottir, M, et al. Paternalism and autonomy: a presentation of a Nordic study on the use of coercion in the mental health care system. Int J Law Psychiatry 2002;25:93-108.CrossRefGoogle Scholar
Hoge, S, Lidz, C, Mulvey, E, Roth, L, Bennett, N, Siminoff, L, et al. Patient, family and staff perceptions of coercion in mental hospital admission: an exploratory study. Behav Sci Law 1993;11:281-93.CrossRefGoogle ScholarPubMed
Monahan, J, Hoge, S, Lidz, C, Roth, L, Bennett, N, Gardner, W, et al. Coercion and commitment: understanding involuntary mental hospital admission. Int J Law Psychiatry 1995;18:249-63.CrossRefGoogle ScholarPubMed
Kaltiala-Heino, RInvoluntary psychiatric hospitalization. A comparison of voluntarily and involuntarily admitted psychotic patients, their experiences of and attitude to coercion in psychiatry. Acta Universitas Tamperensis Ser A 1995;vol. 66 Vammala:Vammalan kirjapaino.Google Scholar
Kaltiala-Heino, R. Methodological issues in measuring coercion in psychiatric care. In: Morrissey, J, Monahan, J, editors. Research in community and mental health, vol. 10. Stamford (CT): JAI Press; 1999 Coercion of Mental Health Services.Google Scholar
Keisling, RCharacteristics and outcome of patients who refuse medication. Hosp Comm Psychiatry 1983;34:847-8.Google ScholarPubMed
Andersen, B, Hansen, EPatientrådgivere og tvang i psykiatrien. Ugeskrift Laeger 1990;152:2292-4.Google Scholar
Rangecroft, MEH, Tyrer, SP, Berney, TPThe use of seclusion and emergency medication in a hospital for people with learning disability. Br J Psychiatry 1997;170:273-7.CrossRefGoogle Scholar
Engberg, MTvangsanvendelse I psykiatrien efter den nye psykiatrilovs indforelse. Ugeskrift laeger 1992;154:1818-21.Google Scholar
Rodenhauser, P, Schwenker, CE, Khamis, HJFactors related to drug treatment refusal in a forensic hospital. Hosp Comm Psychiatry 1987;38:631-7.Google Scholar
Lounamaa, A, Tuori, T, Pelanteri, S. Psykiatria 1996. National Research and Development Centre for Health and Welfare (STAKES); 1997 Tilastotiedote (Psychiatry 1996. Statistics).Google Scholar
Submit a response


No Comments have been published for this article.