Nearly a third of individuals receiving treatment for first-episode psychosis (FEP) or mania (FEM) enter treatment involuntarily, according to a
report in
Psychiatric Services,
and these individuals are more likely to be unemployed or not engaged in education five years after discharge.
Why It’s Relevant
Involuntary hospitalization, while controversial, can assist individuals in crisis when their insight is impaired and they might be at risk to self or others; it can be especially important during a first episode of psychosis or mania because the duration of the untreated illness is associated with worse long-term outcomes. However, there is limited research on how involuntary treatment influences long-term trajectories of FEP/FEM.
By the Numbers
- Researchers used data from the Rochester Epidemiology Project to look at five-year trajectories of 200 individuals with FEP or FEM who entered treatment voluntarily (139) or involuntarily (61).
- At baseline, involuntary patients had slightly more severe illness: Average scores were 5.5 on the Clinical Global Impressions-Severity measure compared with 5.1 for voluntary patients.
- There was no difference in rates of rehospitalization between the two groups, but involuntary patients were significantly more likely to have police involved when they relapsed (61% compared to 26%).
- At five years, involuntary patients had lower scores on the Social and Occupational Functioning Assessment Scale than those who entered treatment voluntarily and were 3.82 times more likely to be disengaged from work or school.
The Other Side
There was no measure of treatments received after the FEP/FEM, so it’s not possible to fully separate the influence of status at entry from later differences in treatment. Nor was there a measure of patients’ insight, which might be an important factor driving some of the effects.
Takeaway Message
The findings support involuntary treatment as a reasonable pathway to care for individuals with FEP/FEM who would otherwise remain untreated. However, persistently lower functioning and higher odds of being unemployed in the involuntary group support the need for targeted vocational interventions.
Related Information
Source
Javier Ortiz-Orendain, et. al. Involuntary treatment in first-episode psychosis and mania: a retrospective population-based cohort study.
Psychiatric Services. Published October 29, 2026. doi:
10.1176/appi.ps.20260138