Forced psychiatric admissions are becoming more serious

PalmIn 2024, 1,020 involuntary psychiatric admissions were recorded in the Balearic Islands, more than half of which (575) took place at Son Espases. Following behind were Son Llàtzer, with 190; Manacor Hospital, with 118; Inca Hospital, with 106; Mateu Orfila Hospital, with 19; and Can Misses, which had 12 such admissions. According to the health experts consulted, this figure has remained stable over the years. What has worsened is the severity of the problems. Most admissions are for psychosis. "Now there are many psychotic episodes because many people are using synthetic drugs. The severity of what we see has increased significantly. The inpatient units, the mental health units... are all full," says Carme Canet, the Psychiatric Nursing Supervisor at Son Llàtzer Hospital.

There's one thing that professionals want to clarify: Involuntary admission doesn't mean they're being admitted violently. "Approximately half of psychiatric hospitalizations are involuntary. While it's true that some patients are firmly opposed to it, others understand that it's what they need," explains Joaquín López, a psychiatrist at Son Espases Hospital. The professional asserts that, in his experience, many of those who are forcibly admitted "have a diagnosis of psychosis, a severe mental disorder associated with loss of judgment, delusions, and being dangerous, both to themselves and to others," he explains.

Involuntary admissions are not resolved immediately. Once the professional decides it is the best option, they must submit the medical report to a tribunal composed of a judge and a forensic doctor, who must decide whether the measure, which involves a restriction of liberty, is proportional and beneficial. Beyond the fact that it is a common procedure, Vicente Galaso, the psychologist responsible for the La Nostra Veu association, believes it violates people's rights and dignity. "It used to be called forced admission, but they've gradually toned down the adjective to make it more politically correct. What remains are the same judicial and medical criteria, but the fact is that if you have cancer, you can decide not to get treatment. Why should they force you to do it if you have it?"

Words, medication, and force

Once the patient is admitted, depending on their condition, various interventions are necessary. López asserts that hospitals in the Balearic Islands have worked to humanize psychiatric care, especially with regard to reducing physical restraints for patients and using dialogue as the basis of treatment. "Physical restraints are still used, but rarely, because there is greater awareness now. It's always a last resort, because we first try verbal restraint, reasoning, and calming. The nursing staff has been extensively trained to help with words alone," he explains. If dialogue isn't enough, pharmacological restraint comes into play, and if this isn't possible, physical force intervenes. "It's a very unpleasant moment that also hurts the healthcare workers involved," he says. ARA Baleares has asked IB-Salut how many physical restraints were used in the Balearic Islands during 2024, but no information has been received. As reported, work is being done to improve mental health records and establish uniform criteria, which are currently unavailable.

Physical restraint has staunch detractors, such as Galaso, who asserts that "it's similar to torture." "I know for a fact that more is done than necessary," she says. At Nuestra Voz, which supports people with serious mental disorders such as schizophrenia and borderline personality disorder, among others, they work with "tenderness restraint," which involves actively listening to the person experiencing an episode. "We all listen, both me and the rest of our colleagues. We've never had to resort to force to calm someone down," she asserts. Based on conversations with users and her knowledge of the mental health system, Galaso draws a conclusion: "Often, in hospitals, verbal restraint is ignored because I've talked to them about tenderness and they laugh at me," she complains.

Adriana Lozano has been volunteering at La Nostra Veu for a year and a half and has learned to treat patients "with love." What she tries to do is make the other person, the one suffering the crisis, feel that she is listening attentively and will do everything she can to help them calm down. It's worth mentioning that one of the problems hospitals face is the boom mental health problems of recent years. Properly providing verbal restraint takes time, and sometimes it isn't available due to healthcare pressure. Furthermore, in Spain, there are only 10 psychiatrists per 100,000 inhabitants, according to data from the Spanish Foundation of Psychiatry and Mental Health.

If there's one idea that both Galaso and Lozano agree on, it's that sometimes physical restraints are used that aren't necessary. The volunteer explains the case of a patient with schizophrenia who went to the emergency room, was told he had to be admitted, and was left in a ward. "Tired of waiting and no one coming, he left. Two men the size of two closets came to get him, took him by force, and signed him on the chair," she explains. "He asked them why they were signing for him if he wasn't violent or opposed anything. They replied that it was because he had run away," she adds. The volunteer explains that the association's users notice that the things that upset them the most and make them feel worse when they're in crisis are precisely being grabbed and put under pressure. "It's like a fish biting its tail. You hold back to try to relax, but what you're doing is upsetting them," she laments.

More humane care

Professionals insist they are working "courageously" to humanize psychiatric care. "We always try to anticipate restraint, because we want to avoid it at all costs. What we want is for the patient to be well," says Canet. One of the keys to improving care involves having friendlier spaces, properly lit and with soothing colors, a concept already being discussed with the administration. "The image of a prison, of having patients completely isolated, is already obsolete. We are moving in the opposite direction, to ensure that everyone has the same rights and their dignity is respected to the fullest," she says.

The nurse also assures that, although some patients are admitted who are not in a condition to provide care, they are informed "at all times" of what is being done and the medications they are being administered. "When there are patients who are admitted repeatedly, the relationship is already closer, and we talk to them to find out what we can do to prevent them from reaching an extreme point," she explains. Even so, sometimes physical restraint is unavoidable. "If someone comes in banging against the wall, biting, and is out of their mind, what should we do? We don't want to restrain them, but we don't have any other effective options," he laments. If someone needs to be signed in, everything is done to keep them there for as little time as possible.

There is a psychiatric practice that many people have seen in movies, but few know is still being done: electroshock therapy. According to López, the technique is used in cases of patients with severe depression. "It's a frowned upon and highly stigmatized technique, but it works," he asserts. The patient is always consented to, and the process is not like what is depicted in science fiction films. The patient is sedated and electric currents are applied for about a minute. The effect on the brain can last for several months, until the patient must repeat the process. Beyond its effectiveness, Galaso mentions its many side effects. "It's like initializing the brain, but you play it without really knowing its indirect consequences, because neuronal complexity makes it difficult to know what might happen. There are cases of people who have had electroshocks and later realized they had lost memories," he laments.

The experts consulted agree on the increase in serious mental illnesses that require medical intervention and that humanizing patient care is essential. "They have mental problems and great psychological suffering, yes, but they are also people and that is how they must be treated," Galaso concludes.