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Research from Switzerland, Poland, Canada, and the US finds that social marginalization, immigration status, education, sex, and psychiatrists’ own characteristics may determine who is subjected to involuntary psychiatric treatment.
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August 28, 2026
This week, Mad in America examines four studies related to patient and psychiatrist characteristics and psychiatric detention. The first finds that social marginalization is linked to higher rates of psychiatric detention and worse clinical improvement.
The second finds that being male, having lower educational attainment, and single marital status are associated with involuntary admission.
The third reports that immigrants and socially disadvantaged people face higher rates of psychiatric detention.
The fourth finds that psychiatrists’ characteristics are linked to significant variation in recommending psychiatric detention.
Together, these studies suggest that decisions around involuntary admission are not always based on clinical necessity, but significantly influenced by patient and psychiatrist characteristics.
Social Marginalization Is Associated With Higher Rates of Psychiatric Detention and Lower Clinical Improvement
A new Swiss study published in the International Journal of Law and Psychiatry finds that a specific demographic profile, including non-Europeans with low socioeconomic status, high rates of social welfare dependence, and temporary residency, is linked to significantly higher rates of psychiatric detention. This research, led by Jana Carlet from the University of Zurich in Switzerland, also reports that clinical improvement after treatment is significantly lower for this group.
The goal of this study was to assess the rates of involuntary admission among identified subgroups of psychiatric patients and to test the hypothesis that groups experiencing multiple forms of social marginalization are more likely to face psychiatric detention. The authors used clinical data from 16,024 adults admitted as inpatients to the University Clinic Zurich between 2017 and 2020 to examine the link between specific demographic profiles and involuntary admission.
Four subgroups of psychiatric inpatients were identified. Class 1 represented 55.1% of admissions and was predominately Swiss citizens with secondary education and average socioeconomic status. Class 2 represented 23.2% of admissions and included mostly European Union foreign nationals with stable residence and some education. Class 3 accounted for 13.9% of admissions and included young Swiss nationals with lower educational attainment. Class 4 represented 7.8% of admissions and included non-European citizens with low socioeconomic status, high rates of social welfare dependence, temporary residency, low educational attainment, and “insufficient” language skills.
After adjusting for clinical variables including diagnosis and symptom severity, class 4 was at a 49% increased risk of involuntary admission compared to class 1. Classes 2 and 3 had nearly identical odds of involuntary admission compared to class 1. Clinical improvement after treatment was also significantly lower in both classes 3 and 4 compared to class 1. This means the group least likely to be helped by psychiatric treatment was at significantly increased odds of being forced into that treatment against their will.
Male Sex, Lower Education, Single Marital Status, and Psychotic Disorders Are Associated With Greater Risk of Psychiatric Detention
A new Polish study published in the International Journal of Law and Psychiatry finds that certain demographic factors are linked to higher rates of psychiatric detention, including male sex, lack of higher education, and single marital status. This study, led by Andrzej Kiejna from the University of Vocational Education in Poland, also finds that female sex, secondary or higher education, and being single were linked to longer psychiatric hospital stays.
The goal of this research was to identify demographic and clinical factors linked to psychiatric detention and longer stays in psychiatric hospitals. The authors used data from questionnaires, hospital statistics, and demographic information collected from all involuntarily detained patients at the Lower Silesian Centre of Mental Health between 2016 and 2022.
Male sex, lack of higher education, single marital status, and a diagnosis of schizophrenia, other psychotic disorders, and alcohol use disorder were linked to higher odds of psychiatric detention.
Female sex, higher education, single marital status, emergency or legally based admission, history of previous psychiatric hospitalization, and schizophrenia diagnosis were all linked to longer lengths of stay.
Immigrants and Socially Disadvantaged Patients Face Higher Odds of Psychiatric Detention
A new Canadian study published in Psychiatric Services finds that demographic factors such as being an immigrant, homelessness, having no income, and lower educational attainment are linked to psychiatric detention. This research, led by Soyeon Kim from McMaster University in Canada, also finds that while immigrants were less likely to face involuntary psychiatric assessment, they were more likely to be detained against their will in a psychiatric facility.
The goal of this research was to investigate whether certain demographic factors were linked to a higher likelihood of psychiatric detention. The authors examined administrative and clinical data from 53,088 people that were detained against their will in a psychiatric hospital in Ontario, Canada.
After adjusting for clinical variables, both recent (37% higher odds) and long-term (51%) immigrants were more likely to face psychiatric detention compared to non-immigrants. Homeless people (87%) and those with no income (43%) also faced increased odds of psychiatric detention. Having some level of university education was linked to 16% lower odds of involuntary admission.
Homeless people (73% higher odds) were more likely to face involuntary psychiatric assessment. Indigenous people had tripled odds of facing involuntary psychiatric assessment, but were not more likely to be involuntarily admitted. Immigrants had lower odds of involuntary assessments (19%), but increased odds of psychiatric detention.
These three previous studies each had three main limitations. The authors used routinely collected administrative and clinical data which lacked some significant details such as reasons for migration, explicit ethnicity, qualitative markers of structural discrimination, and information on qualitative markers of systemic discrimination. The design of the studies means the results cannot speak to causes, only associations. These studies were conducted in specific geographical locations within a small number of inpatient facilities, significantly limiting generalizability to other populations.
Psychiatrist Characteristics Are Linked to Significant Variation in Detention Recommendations
A new US study published in PLOS Mental Health finds that some psychiatrist characteristics, such as location, type of clinical experience, and levels of paternalism, are linked to a higher likelihood of recommending psychiatric detention. This study, led by Karin R. Lavie from the University of Chicago, also reports that psychiatrists’ demographics and overall years of experience were not linked to their likelihood of recommending involuntary admissions.
The goal of this research was to investigate psychiatrist factors that were linked to increased likelihood of recommending psychiatric detention. The authors also wanted to evaluate how psychiatrists’ characteristics were linked to their level of confidence in recommending involuntary admission.
They invited psychiatrists and psychiatry trainees from eight academic departments in the US to participate in an online survey around these questions. Each participant was presented with eight hypothetical psychiatric emergency situations and asked to indicate if they would recommend psychiatric detention or discharge. They also rated their confidence in their decision on a scale from 0 to 100. In total, the authors used data from 246 participants.
There was substantial variation in the recommendation of psychiatric detention between psychiatrists. Overall, 48% of responses to the hypothetical emergency psychiatric situations recommended involuntary admission. The average confidence in those decisions was 68 out of 100.
Psychiatrists and trainees located in the Northeast and Southeast were significantly more likely to recommend psychiatric detention compared to their peers in the Midwest, Southwest, and West. Those that had worked in inpatient settings were also more likely to recommend involuntary admission while participants that had previous experience in a psychiatric emergency service were less likely to recommend the same. Paternalistic attitudes, belief that hospitalization benefited patients, and higher levels of comfort with clinical risk were all linked to higher rates of recommending psychiatric detention. Experience working in emergency situations and higher levels of comfort with clinical risk were both linked to higher confidence in psychiatrists’ and trainees’ decisions.
This study had three main limitations. The design of the study means the data can only speak to associations between psychiatrists’ characteristics and psychiatric detention recommendations, not causes. Only psychiatrists and psychiatric trainees from academic institutions in five US states were included in the current work, limiting generalizability to other populations. The situations were hypothetical and may not truly indicate how participants would respond in an actual emergency situation.
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Carlet, J., Hotzy, F., Maatz, A., Homan, P., & Müller, M. (2026). Analysing risk factors for involuntary admission from an intersectional perspective: A latent class analysis. International Journal of Law and Psychiatry, 105, 102191. (Link)
Kiejna, A., Cichoń, E., Stachów, M., Gondek, T. M., Bukowska, A., & Todzia-Kornaś, A. (2026). Admission without consent to a psychiatric ward and length of hospital stay: The role of selected sociodemographic and clinical factors. International Journal of Law and Psychiatry, 107, 102222. (Link)
Kim, S., MacQuarrie, E., Oh, S., Do, R., Ham, E., Hilton, N. Z., & Fung, K. P. (2026). Social Determinants and trends in involuntary psychiatric detentions: A decade of population-based data. Psychiatric Services, 77(8), 709–717. (Link)
Lavie, K. R., Lee, R., & Jacobson, K. C. (2026). Identifying psychiatrist characteristics associated with likelihood of recommending involuntary hospitalization for patients using a novel tool to assess decision-making. PLOS Mental Health, 3(4). (Link)
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Richard Sears teaches psychology at West Georgia Technical College and works as a counseling psychologist in private practice, specializing in person-centered therapy. Earlier in his career, Richard worked in a psychiatric crisis stabilization unit, an experience that exposed him to the harsh realities of a broken mental healthcare system. This fueled his commitment to providing compassionate, person-centered care and advocating for meaningful change in how mental health services are delivered.
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