Involuntary psychiatric treatment in Reggio Emilia: local findings from the SIEP multicenter study

TL;DR

This study examines involuntary psychiatric treatment in Reggio Emilia, Italy, finding that prior treatment history and service organization strongly influence treatment duration and restraint use.

Contribution

The study provides local insights into factors affecting involuntary psychiatric treatment outcomes in Italy, emphasizing organizational and clinical influences over demographic ones.

Findings

A history of prior involuntary treatment was strongly linked to treatment renewal.

Schizophrenia and delusional disorders were associated with longer hospitalizations.

Male patients were more frequently subjected to mechanical restraint than female patients.

Abstract

Involuntary psychiatric treatment (IPT) remains a controversial practice, raising clinical, ethical, and organizational concerns. In Italy, despite legal safeguards, substantial variability persists across regions, reflecting differences in clinical presentation, service organization, and staff attitudes. As part of the national multicenter project promoted by the Italian Society of Psychiatric Epidemiology (SIEP), this study reports findings from the Reggio Emilia site, exploring factors associated with IPT duration, renewal, and the use of mechanical restraint.

All adult patients admitted under IPT to the Psychiatric Diagnosis and Treatment Unit of Reggio Emilia between March 2023 and March 2024 were included (N = 214). Data were collected with standardized SIEP forms and analyzed using descriptive and inferential statistics.

The mean duration of IPT was 7.4 days (SD = 3.8). A history of prior IPT was strongly associated with renewal (37.7% vs. 11.9%, p < 0.001). First-ever contact and conversions from voluntary admission were not significant. Schizophrenia and delusional disorders were associated with longer hospitalizations (p < 0.01). Male patients were more often mechanically restrained (10.8% vs. 1.1%, p = 0.006), though duration did not differ by gender. Differences in IPT duration across validation settings were observed; however, post hoc analyses indicated that these were primarily driven by a small subgroup of cases validated in residual or atypical services, while emergency, inpatient, and community pathways showed broadly comparable durations.

Overall, prior coercion history and organizational factors appeared to play a more prominent role than demographic characteristics in shaping IPT-related outcomes. These findings highlight the importance of strengthening community-based alternatives, early intervention strategies, and bias-aware staff training to reduce reliance on coercive practices.