Mental health professionals' beliefs and attitudes towards compulsory admission in Athens: a token of social stigma or good faith in psychiatry?-a cross-sectional study.

Abstract

Background: Mental health professionals' (MHPs) attitudes towards involuntary admissions have not received adequate attention in efforts to curb their rates. Thus, the present study set out to (i) explore MHP attitudes regarding involuntary hospitalisation, (ii) describe their perceived dangerousness of people with severe mental illness (SMI) and their trust in psychiatry, (iii) identify the predictors of attitudes towards compulsory admissions and (iv) gauge the contribution of perceived dangerousness versus trust in psychiatry to explaining them.

Methods: A random sample of 300 mental health professionals working in public mental health services located in the Northern part of Athens and in the two psychiatric hospitals of Attica participated in the study. Respondents had to complete a self-reported instrument garnering information about participants' attitudes towards involuntary hospitalisation (original scale), the perceived dangerousness of people with SMI (Perceived Dangerousness Scale) and their trust in psychiatry (based on the Attitudes to Mental Illness scale) as well as various socio-demographic and work-related variables.

Results: Respondents largely accepted involuntary hospitalisations, considering them to be beneficial (72.96%) and disagreeing with the view that they adversely influence the course of illness (54.85%). Nonetheless, they believe that people with SMI should be treated in the community (89.93%), that compulsory admission should be the last therapeutic resort (84.01%) and that people with SMI should not be placed in psychiatric hospitals against their will in order to be under surveillance (90.64%). However, they acknowledge that involuntary admission is often the only treatment options(61.19%). Concomitantly, they report moderate levels of perceived dangerousness and high levels of trust in psychiatry. Trust in psychiatry had the strongest positive association with acceptance of involuntary hospitalisation among mental health professionals whereas postgraduate studies and working in outpatient settings were linked to less favourable attitudes. Interestingly, perceived dangerousness did not yield an independent effect; rather, it weakened the association between trust in psychiatry and acceptance of involuntary admissions.

Conclusions: Mental health professionals hold complex attitudes towards involuntary hospitalisation, which are largely explained by their trust in psychiatry. Efforts to reduce the rates of involuntary admissions should address both them and their determinants.