16. Involuntary commitment is commonly purported to be a last-resort exception, but evidence shows that this is not the case. Despite the overall reduction of inpatient beds in mental health facilities globally, compulsory admission rates seem to be rising across regions, particularly in high-income countries. For example, a significant increase is reported in several European countries.⁷ Involuntary admissions are also increasing in many countries from the Americas, the Middle East and East Asia.⁸ Even when admissions are formally voluntary, in most countries “acute inpatient psychiatric wards” are locked and individuals cannot leave the facilities at will. Moreover, voluntary admissions may not truly reflect the individual’s free and informed consent as they may be expressed under the threat of involuntary commitment. Long-term hospitalization of 12 months or longer is still prevalent in some countries.⁹
⁷ A. Turnpenny and others, Mapping and Understanding Exclusion: Institutional, Coercive and Community-based Services and Practices across Europe (Mental Health Europe and University of Kent, 2017).
⁸ M. Lebenbaum and others, “Prevalence and predictors of involuntary psychiatric hospital admissions in Ontario, Canada: a population-based linked administrative database study”, British Journal of Psychiatry Open, vol. 4, No. 2 (2018), pp. 31–38; J.A. Bustamante Donoso and A. Cavieres Fernández, “Internación psiquiátrica involuntaria. Antecedentes, reflexiones y desafíos”, Revista Médica de Chile, vol. 146 (2018), pp. 511–517; A. Bauer and others, “Trends in involuntary psychiatric hospitalization in Israel 1991–2000”, International Journal of Law and Psychiatry, vol. 30, No. 1 (2007), pp. 60–70; and A. Kim (2017), “Why do psychiatric patients in Korea stay longer in hospital?”, International Journal of Mental Health Systems, vol. 11, No. 2.
⁹ Turnpenny and others, Mapping and Understanding Exclusion, p. 41.