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Involuntary psychiatric treatment
Abstract
In an interview study carried out in the Psychiatric Clinic of Tampere University Hospital, patients with functional psychoses showed positive attitudes towards involuntary psychiatric hospitalization as a societal issue. The legal status of the interviewees did not distinguish between their opinions, but the patients' personal experience of being coerced was related to less favourable attitudes. Patients' attitudes are discussed in relation to civil rights, paternalism, individualism, and collectivism.
... Researchers have given more attention to patients' experience of involuntary hospital care. Contrary to what might be expected, some studies have found that compulsory inpatients subsequently hold generally favourable views of their hospitalization and treatment (Gove & Fain, 1977;Edelsohn & Hiday, 1990;Kaltiala-Heino, 1996), and many will later agree it was required (Spence, Goldney, & Costain, 1988;Conlon, Merskey, Zilli, & Fromhold, 1990;Edelsohn & Hiday, 1990;Kaltiala-Heino, 1996;Gardner et al., 1999). ...
... Researchers have given more attention to patients' experience of involuntary hospital care. Contrary to what might be expected, some studies have found that compulsory inpatients subsequently hold generally favourable views of their hospitalization and treatment (Gove & Fain, 1977;Edelsohn & Hiday, 1990;Kaltiala-Heino, 1996), and many will later agree it was required (Spence, Goldney, & Costain, 1988;Conlon, Merskey, Zilli, & Fromhold, 1990;Edelsohn & Hiday, 1990;Kaltiala-Heino, 1996;Gardner et al., 1999). ...
Background:
New Zealand operates a well-embedded community treatment order scheme for patients with serious mental disorders. A similar scheme may be enacted for England and Wales.
Aim:
To explore the views of patients with recent experience of community treatment orders.
Method:
All patients in one region under an order in the last 2 years, not readmitted to hospital for at least 6 months, were included, subject to their capacity and consent. Forty-two patients out of 84 potential participants were interviewed.
Results:
The majority of patients were generally supportive of the community treatment order, especially if the alternative was hospital. Many valued the access to services and sense of security obtained, and attributed improvements in their health to treatment under the order. They also experienced reduced choice about medication and restrictions on residence and travel. For a minority this meant they were strongly opposed to the order, but for most the restrictions did not unduly hinder them. The majority of patients viewed the order as a helpful step towards community stability.
Conclusions:
The usefulness of community treatment orders is accepted by most patients under them in NZ, as well as by most psychiatrists. Critical factors include the quality of therapeutic relationships and the structure provided for community mental health care.
... Studies of perceived coercion among patients in mental health treatment suggest that although legally mandated treatment is often associated with higher levels of perceived coercion, considerable variation exists and other factors such as respect, empathy, choice are often more important than legal status in explaining perceived coercion (7)(8)(9)(10). Findings are also mixed with regard to the association between perceived coercion and adherence to outpatient treatment or medication (9,(11)(12)(13). ...
Objective:
Although jail diversion is considered an appropriate and humane response to the disproportionately high volume of people with mental illness who are incarcerated, little is known regarding the perceptions of jail diversion participants, the extent to which they feel coerced into participating, and whether perceived coercion reduces involvement in mental health services. This study addressed perceived coercion among participants in postbooking jail diversion programs in a multisite study and examined characteristics associated with the perception of coercion.
Methods:
Data collected in interviews with 905 jail diversion participants from 2003 to 2005 were analyzed with random-effects proportional odds models.
Results:
Ten percent of participants reported a high level of coercion, and another 26% reported a moderate level of coercion. Having a drug charge was associated with lower perceived coercion to enter the program. In addition, an interaction between sexual abuse and substance abuse indicated that recent sexual abuse was associated with higher levels of perceived coercion, but only among those without current substance abuse. At the 12-month follow-up (N=398), variables associated with higher perceived coercion to receive behavioral health services included spending more time in jail and higher perceived coercion at baseline. The amount of behavioral health service use was not predicted by perceived coercion at baseline. Rather, being older, having greater symptom severity, and having a history of sexual abuse but no substance abuse and no history of physical abuse were associated with higher levels of outpatient service use.
Conclusions:
Overall, one-third of jail diversion participants reported some level of perceived coercion. Important determinants of perceived coercion included charge type, length of time in jail, and sexual abuse history. Engagement in treatment was not affected by perceived coercion.
... The more permissive commitment criteria for minors are motivated by their need for greater protection from harmful treatment refusals. The concept of competence is not mentioned in the Mental Health Act but it is implied in the Patients' Status and Rights Act (785/1992) and Mental Health Act that minors need a more paternalistic approach due to the fact that their age and developmental level do not enable them to understand information and rationally consider the ramifications of their choices (Kaltiala-Heino 2003). ...
Finland does not have a history of providing forensic adolescent psychiatric units although the need for this kind of service has been established. According to legislation patients who are minors have to be treated separately from adults, however, this has not been possible in practice. Also, adolescent psychiatric wards have not always been able to admit the most severely ill patients, those with impulsive and aggressive behaviours, because of lack of staff resources, problems associated with protecting other vulnerable patients and a shortage of secure environments. A previous report demonstrated the significant increase in adolescent's involuntary treatment within adult psychiatric wards. Data from this report were acknowledged as an important starting point in the planning process for the psychiatric treatment and research unit for adolescent intensive care. This paper describes the background, development process, plan of action, tailor-made education programme and supporting evidence for the first Finnish adolescent forensic service opened in April 2003 in the Department of Psychiatry, Tampere University Hospital. The tool used for planning the unit's activities and staff education programme was the Balanced Score Card approach, the structure and development of which is also outlined within the paper.
... The issue of competency is central to the justification of coercive treatment (Breeze, 1998;Kaltiala-Heino, 1996;Kaltiala-Heino & Valimaki, 1999;Lutzen, 1998;O'Brien & Golding, 2003;Olsen, 2003;Pescosolido, Monahan, Link, Stueve, & Kikuzawa, 1999;Syse, 1999); psychiatric disabilities are assumed to reduce competence, and coercion is assumed to be a just response (O'Brien & Golding, 2003;Pescosolido et al., 1999;Playle & Keeley, 1998;Terkelsen, 1993). Implicit in this justification is a relationship between the degree of psychiatric disability and the need for coercion: If lack of competence is assumed to be related to psychiatric disability and is cause for coercion, then those experiencing more significant disability-related effects would be expected to receive more coercive services. ...
In community mental health, limitation of service recipient choice and freedom takes place through mechanisms ranging from subtle to blatant. The justification of coercion in these settings typically focuses on recipient deficits. We argue that this focus must shift to the service system itself, and that the most successful efforts to improve recipient engagement will be those that support respectful provider-recipient relationships and the delivery of services that help recipients achieve goals of their choosing.
... By interview time patients had been treated and many had responded positively to their treatment. Studies have shown that attitudes of patients toward their mental hospitalization change from admission to discharge, becoming more positive, and that the change is related to their feelings of being helped by hospitalization and the treatment received (Beck & Golowka, 1988: Edelsohn & Hiday, 1990; Gove & Fain, 1977: Hiday, 1992; Kaltiala-Heino, 1996; Kane et al., 1983; Kjellin et al.~ 1993: Westrin et al., 1990). It may be, therefore, that our respondents reported less coercion than they would have had we interviewed them at time of admission. ...
Our analysis confirms the findings of previous studies that considerable variation exists in patient perceptions of coercion. That we find such variance even among our sample members who were all legally involuntarily hospitalized supports the findings of previous studies that objective legal status and subjective feelings of coercion are not equivalent. Not surprisingly, the modal score indicated high levels of perceived coercion; but at the same time, an almost equal number of patients perceived little or no coercion. Our distribution on this variable is very similar to that reported by Gardner et al. (1993) whose sample had a majority of legally voluntary patients, a majority without a diagnosis of psychosis, and a much larger proportion with a primary diagnosis of substance abuse. Both samples were distributed across the full range of the perceived coercion scale with marked bimodality, although the proportion in our sample experiencing high coercion was almost 50% larger, and the proportion experiencing low coercion was approximately 50% smaller. As with perceived coercion, considerable variation existed across the full range of the negative pressures and process exclusion scales, indicating that the process of civil commitment does not necessarily involve the stereotypical picture of a resisting mental patient being dragged into a mental institution. Approximately two-fifths of our sample reported little or no negative pressures and little or no process exclusion in their hospital admission. These findings suggest that involuntary admission to a mental hospital can permit patients to feel like they have voice and validation, and can avoid force even in the absence of choice. The challenge is to try to extend to all patients at the time of their admission a demonstration in word and action that they are person with opinions, desires, rights, and dignity, and not just mental patients in an acute crisis. Clinical variables could not account for differences in outcome variables. Neither type of disorder, secondary substance abuse, personality disorder, hostility/suspiciousness, severity of symptoms nor number of recent hospital admissions affected how patients viewed the hospital admission process. This may suggest that some element of the shared characteristic of chronicity or recidivism negates expected differences among clinical groups. Patients who were young, urban, unmarried, and of low education were no more likely to perceive coercion, negative pressures, or process exclusion. This finding was unexpected because they are more likely to resist hospitalization, more likely to be seen as dangerous and in need of force to be hospitalized, and more likely to have had previous negative experiences with authority. Instead, it was white, female, unmarried respondents with more education who were more likely to perceive higher levels of our dependent variables. Such higher status persons have more resources, autonomy, and control in their daily work and family roles. They are the ones more likely to perceive coercion, negative pressures, and process exclusion in hospital admission, possibly because their expectation levels and reference groups make them more aware of the use of coercion and any deprivation in autonomy. The MacArthur study has found that patients who have little voice or validation, and against whom force and threats are used to get them hospitalized, perceive high levels of coercion; that is, procedural inequity and negative pressures predict perceived coercion (Lidz et al., 1995). Our sample, with different measures of these three constructs, found strong positive correlations among the three. When Negative Pressures and Process Exclusion were added to the model predicting perceived coercion, they were highly significant and wiped out the associations of perceived coercion with gender, race, cohabitation, and education. Although those basic and acquired demographic variables predict Negative Pressures and Process Exclusion, they do not predict perceived coercion directly. Rather, as the MacArthur group found, the two procedural variables, using force with patients and including patients in the process of hospital admission, are the most important factors in perceiving coercion.
Increasing patient autonomy and decreasing coercion are frequently cited goals in mental health care. Research suggests that the therapeutic relationship and patients' experiences of coercion may be associated. This study investigated the association between the therapeutic relationship and perceived coercion in psychiatric admissions.
Associations between perceived coercion and the therapeutic relationship and sociodemographic and clinical variables were examined by using data from structured interviews with 164 patients consecutively admitted to two psychiatric hospitals in Oxford, England.
High levels of coercion were experienced by 48% of voluntarily and 89% of involuntarily admitted patients. A high perceived coercion score was significantly associated with involuntary admission and a poor rating of the therapeutic relationship. The therapeutic relationship confounded legal status as a predictor of perceived coercion.
Similar factors may influence patients' experience of both coercion and the therapeutic relationship during psychiatric hospital admission. Hospitalization, even when voluntary, was viewed as more coercive when patients rated their relationship with the admitting clinician negatively. Interventions to improve the therapeutic relationship may reduce perceptions of coercion.
In 2009 the WPA President established a Task Force that was to examine available evidence about the stigmatization of psychiatry and psychiatrists and to make recommendations about action that national psychiatric societies and psychiatrists as professionals could do to reduce or prevent the stigmatization of their discipline as well as to prevent its nefarious consequences. This paper presents a summary of the Task Force's findings and recommendations. The Task Force reviewed the literature concerning the image of psychiatry and psychiatrists in the media and the opinions about psychiatry and psychiatrists of the general public, of students of medicine, of health professionals other than psychiatrists and of persons with mental illness and their families. It also reviewed the evidence about the interventions that have been undertaken to combat stigma and consequent discrimination and made a series of recommendations to the national psychiatric societies and to individual psychiatrists. The Task Force laid emphasis on the formulation of best practices of psychiatry and their application in health services and on the revision of curricula for the training of health personnel. It also recommended that national psychiatric societies establish links with other professional associations, with organizations of patients and their relatives and with the media in order to approach the problems of stigma on a broad front. The Task Force also underlined the role that psychiatrists can play in the prevention of stigmatization of psychiatry, stressing the need to develop a respectful relationship with patients, to strictly observe ethical rules in the practice of psychiatry and to maintain professional competence.
Although jail diversion is considered an appropriate and humane response to the disproportionately high volume of people with mental illness who are incarcerated, little is known regarding the perceptions of jail diversion participants, the extent to which they feel coerced into participating, and whether perceived coercion reduces involvement in mental health services. This study addressed perceived coercion among participants in postbooking jail diversion programs in a multisite study and examined characteristics associated with the perception of coercion.
Data collected in interviews with 905 jail diversion participants from 2003 to 2005 were analyzed with random-effects proportional odds models.
Ten percent of participants reported a high level of coercion, and another 26% reported a moderate level of coercion. Having a drug charge was associated with lower perceived coercion to enter the program. In addition, an interaction between sexual abuse and substance abuse indicated that recent sexual abuse was associated with higher levels of perceived coercion, but only among those without current substance abuse. At the 12-month follow-up (N=398), variables associated with higher perceived coercion to receive behavioral health services included spending more time in jail and higher perceived coercion at baseline. The amount of behavioral health service use was not predicted by perceived coercion at baseline. Rather, being older, having greater symptom severity, and having a history of sexual abuse but no substance abuse and no history of physical abuse were associated with higher levels of outpatient service use.
Overall, one-third of jail diversion participants reported some level of perceived coercion. Important determinants of perceived coercion included charge type, length of time in jail, and sexual abuse history. Engagement in treatment was not affected by perceived coercion.
Cuts in resources for Finnish psychiatric care may jeopardize the realization of patients' rights in mental health settings. The right to complain is a basic right of all patients in Finland, and is especially important to patients treated involuntarily and also to those who have experienced coercive treatment methods during their hospitalizations. In Finland, a patient's right to complain is guaranteed by law, both in legislation and in national quality recommendations. The complaint process in Finland is very complex, and there are several ways to make a complaint that are not always familiar to patients with severe illnesses. Psychiatric patients may have cognitive impairments that make the formulation of a complaint difficult. Despite help from the patient ombudsman, unbalanced power structures in psychiatric hospitals, insufficient information and long evaluation of appeals makes the complaint process very demanding for psychiatric patients.
In 1979, the state of Washington broadened its criteria governing the involuntary commitment of the mentally ill. This study examined the impact of the revised law on involuntary and voluntary admissions and on the type of patient admitted to state hospitals in Washington. The short-term effect of the law was an abrupt increase in involuntary commitments, with a concomitant but not offsetting decline in voluntary admissions. Although the law resulted in a substantial change in admissions policy, it does not appear to have altered the type of patient admitted to state mental hospitals in Washington.
Reviews literature on the evaluation of consumer satisfaction with mental health treatment. The methods of assessing consumer satisfaction, methodological issues in studies assessing satisfaction, results of the studies, and the value of consumer evaluation are discussed. Consumer evaluation is found to be a useful though flawed method of assessing services. It is concluded that consumer evaluation should be included in a multimethod treatment evaluation. (3 p ref) (PsycINFO Database Record (c) 2006 APA, all rights reserved).
Rather than eliminate the terms “mental health and illness” because of the grave moral consequences of psychiatric labeling,
conservative definitions are proposed and defended. Mental health is rational autonomy, and mental illness is the sustained
loss of such. Key terms are explained, advantages are explored, and alternative concepts are criticized. The value and descriptive
components of all such definitions are consciously acknowledged. Where rational autonomy is intact, mental hospitals and psychotherapists
should not think of themselves as treating an illness. Instead, they are functioning as applied axiologists, moral educators,
spiritual mentors, etc. They deal with what Szasz has called “personal, social, and ethical problems in living.” But mental
illness is real.
• Relatively few social scientists have collected quantitative data on the attitudes of patients toward the staff of mental hospitals. The present report is a review of this body of research, with special consideration given to ascertaining the degree of patients' favorableness to staff. Results indicated that in 21 of the 27 different samples reviewed (78%), patients had favorable attitudes. Patients proved to be somewhat more favorable to staff at mental hospitals generally than staff at their own institution. Type of hospital and time of study had a negligible impact on patients' views. Staff in lower ranks in the hospital hierarchy or in nontherapeutic roles usually received lower evaluations. A content analysis of the attitude measures revealed that patients are quite positive about staff's accessibility, receptivity, support, and training, but somewhat negative toward staff's permissiveness and control. Few social or psychiatric variables were observed to affect patients' responses.
It may be considered unbecoming to appear overly enamored of another's research. That appearance risks collegial opprobrium for the seeming abdication of one's critical faculties. It is thus with caution that I observe that the series of three articles by Segal et al1-3 in this issue are remarkably thoughtful and thought provoking. They do what good research should: answer previously unanswered questions, suggest new ones, interweave the relevant literature, and grapple with the policy implications of their conclusions. For articles about civil commitment, this latter point is particularly necessary.
Notwithstanding the sophistication of their observations, the authors make but three fundamental points, points that fit not so coincidentally the publishing format. Besides reviewing the literature and discussing their methodology, the first article essentially concludes that the clinicians in those settings observed by the authors follow a predictable See also pp 748, 753, and 759. set of rules in determining
The present paper deals with compulsory admissions to psychiatric institutions in Scandina via. In the first part, some historical reflections are given. It seems that the mental health acts occur and are revised simultaneously in each country. Major reforms seem to follow periods of progress in medicine and are based on optimistic attitudes towards treatment possibilities. What the actual situation concerns, admission rates are discussed in relation to the existing mental health acts in the different countries. It is shown that these admission rates vary considerably between the Scandinavian countries, regarding total admissions and compulsory admissions. In Sweden the number of compulsorily admitted patients per 100,000 inhabitants is 248, in Norway 109 and in Denmark 26 (1982 figures). It is difficult to explain the differences demonstrated without including cultural aspects as well as different attitudes towards compulsion.
Furthermore, procedures for carrying out compulsion as well as requirements for detention are discussed. It is worth mentioning that both in Sweden and Denmark voluntarily admitted patients can be retained involuntarily once inside the hospital, while this is impossible in Norway. The formal requirements for this retainment are extremely weak in Denmark. The opportunities offered to patients to oppose the decision on compulsory retainment are also discussed.
Finally, some strategies for reducing compulsion are mentioned. To achieve this, one could narrow the criteria given in the mental health act, and exclude legislation that allows compulsory admissions for the reasons of the treatment possibilities given.
Committed and voluntary patients were interviewed about their experience of psychiatric care. They were interviewed twice: at discharge or 3 weeks after admission and 4-8 months later. Only a few of the patients thought that they should not have been admitted, but many of them thought they had been admitted too late and discharged too early. Sixty-five per cent of the committed patients and 35% of the voluntary patients understood that they had been subjected to compulsory procedures. The law states that the patients must take part in the planning of the treatment concerning themselves; even so, half of them had the feeling of not being allowed to do so. Only 40% of the patients would like to receive the same treatment again. At the second interview 85% of the committed patients stated that it is necessary to have an opportunity to command people and that doctors are very well adapted to make the decision. Only 4% thought that a lawyer should decide.
Thesis (doctoral)--Tampereen yliopisto, 1985. Extra t.p. with thesis statement inserted. Summary in English. Includes bibliographical references (p. 192-200).
This article deals with the effect of the shift in emphasis from the moral rights to the legal rights concept in psychiatry with reference to matters such as involuntary civil commitment, the right to treatment, the right to refuse treatment, the duty to warn or to protect, the duty to protect future patients from abusive colleagues and the duty to become politically active.
Admission to a close ward was analyzed at the Department of Psychiatry, University of Oulu using 888 patients and their 1861 assessment and treatment episodes. Of all referrals for involuntary assessment (n = 237, 12.7% of all episodes) a total of 44 (2.4%) used "questionable" juridical criteria: the final diagnosis was not psychosis. In the follow-up, the admission of the questionable patients was mainly considered a clinical necessity, and at least one third of them were diagnosed as being psychotic and 2 committed suicide. An elevated probability of belonging to the questionable group was seen among patients in their first treatment episode, with minimal professional education, female sex, short treatment time, or residence in a rural area. The result suggests that some inequality existed between women and men, less and more educated and residents of urban and rural areas. The results also reflect conflict between the ethics and clinical practice of involuntary commitment, and the phrasing of the law, especially its diagnostic limitation to psychotic states only.
The authors interviewed adult civil commitment excandidates about their perceptions of commitment six months after discharge. Scales were developed for the following constructs: perceived need of commitment, perceived personal consequences of commitment, view of medication, view of primary hospital physician, and view of hospital experience. Excandidates had a mixed view of commitment. The majority reported positive views, but a substantial minority endorsed negative descriptors.
This study examines the attitudes toward committal of patients admitted to a psychiatric facility for the first time. Sixteen patients, from a group of 28 patients consecutively admitted to hospital on an Ontario Form 1 certificate were able to complete a satisfactory interview. In general, patients viewed the committal procedure favourably. They endorsed medical professionals as being best qualified to institute the committal procedure. A discrepancy between behaviour documented on the committal form and the patients' own perception of their mental state at the time of committal was noted. These findings are discussed with reference to previous research on civil commitment.
The discussion concerning who should be committed and by whom, has dominated the psychiatric literature for many years (1). More recently, the issue of whether committal allows merely for incarceration in the least restrictive alternative or whether it also entitles patients to be treated against their will, if necessary, has also received attention (2-5). As yet, few studies have attempted to define the characteristics of the committed population (6-11). Even fewer studies have attempted to define what patients themselves thought of their committal to hospital (12-15) and for the most part, have not obtained their opinions regarding the broader issues of committal that are being debated in the professional literature. This study seeks to elicit the opinions of patients in these matters.
In 10 of the 13 cases the author examined, after passage of a state statute affecting involuntary admission to state psychiatric hospitals the percentage of involuntary admissions changed significantly in the direction intended by the legislature. The findings support the hypothesis that state laws significantly influence involuntary admission rates and, consequently, clinical practice. The findings also demonstrate that legislative intent in the late 1960s and early 1970s supported restriction of involuntary hospitalization and that a move toward liberalization of its use occurred in the late 1970s. The author recommends greater involvement by psychiatrists in the formulation of legislation that has an influence on their clinical work.
Conflict exists between medical model and civil liberties approaches to involuntary hospitalization for mental illness. The amassing and analysis of data will not resolve this conflict because the two sides view the problem from differing moral vantage points. Medical model adherents are influenced chiefly by utilitarian or consequentialist considerations, while the civil libertarians take more of a deontological or absolutist position. Opinions about such issues as hospitalization criteria of dangerousness versus medical necessity and the relative role of rights versus obligations and of autonomy versus paternalism can be seen largely to depend on such underlying value judgments. Neither side has a monopoly on truth or right in the question of involuntary hospitalization.
Patient satisfaction with psychiatric treatment can strongly influence pursuit and use of mental health services as well as treatment compliance and treatment outcome. Although assessment of patient satisfaction is crucial to designing effective mental health programs, no standard methodology exists to measure satisfaction; thus it is difficult to compare findings from different satisfaction studies. The author examines the studies in four areas of satisfaction research: patient satisfaction with treatment, with participation in research, with participation as subjects in psychiatric teaching, and with involuntary commitment. He notes the variance between mental health professionals' expectations of patient satisfaction and the higher satisfaction that patients themselves report. He also discusses the need for more study of the subjective experience of patients who participate in research projects, teaching conferences, and observed psychotherapy and who undergo involuntary commitment.
In Sweden, recommendations and reforms in psychiatric care have increasingly stressed respect for patient autonomy and justice with less emphasis on medical and social paternalism. This is the official policy. But what are the attitudes of the people involved in or affected by compulsory psychiatric care? To answer this question, the attitudes of committed and voluntarily admitted patients, their relatives, psychiatric staff, health and welfare personnel of primary care and a sample of the general public were studied in 2 Swedish counties. Strong support for medical and social paternalism was reported, and according to most of the people asked, doctors, not legal authorities, should decide about commitment. These attitudes are discordant with the recent legislative changes in Sweden.
The criminalization of mentally disordered behaviour
- M Abramson
Tvangsindlaeggelsen pa Fredriksberg Hospital i perioden 1. nov 1987 til 30
- A K Stender
- K H Aggemaes
- Chodoff P
Onko välittömän hoidon tarpeen ar-vioiminen lääketieteellinen vai juridinen kysymys
- V Lehtinen
Tahdosta riippumaton hoito I ja n
- K Pylkkänen
Pirkanmaan psykiatriset laitos- ja kuntoutuskotipotilaat. Tampereen Ylio-pistollinen Sairaala
- R Salokangas
- S Saarinen
Psykiatrisk tvångsvård-konverterade och icke-konverterade patienters attityder
- R Persson
- T Ohrt
- I Sjodin
- G Elia
- L-H Thorell
Frihedsberövelse i psykiatrin efter den nye psykiatrilovs indförelse
- M Engberg
Sairaalasta kotiutetut skitsofreniapotilaat (SKS-projekti). I. Vuonna 1986 kotiutettujen potilaiden kliininen ja toiminnallinen tila, hoito- ja tukipalveluiden käyttö sekä niiden arvioitu tarve
- R Salokangas
- S Saarinen
- M Ojanen