When emergency clinicians initiate involuntary psychiatric admissions, the consequences may extend beyond the immediate crisis. A Spanish study explored how these interventions affect both patients and healthcare professionals.

Out-of-hospital emergency medical professionals frequently encounter situations in which involuntary admission to a healthcare facility is necessary. In these exceptional circumstances and in accordance with current healthcare legislation, coercive measures may be required when an individual lacks the capacity to provide informed consent or poses a risk to themselves or others. Researchers are calling for greater psychological support and training of the clinicians involved in these interventions.

To better understand these interventions and their consequences, researchers launched a study 2 years ago examining involuntary admissions managed by emergency services. Sponsored by the Catholic University of Murcia, Murcia, Spain, the project involved emergency medical technicians, nurses, and physicians from emergency medical services throughout Spain.

Speaking with El Médico Interactivo, part of the Medscape Professional Network, Enrique Cordero, MD, emergency physician, psychologist, and member of the Spanish Society of Emergency Medicine (SEMES), described the study as examining the relationship between sociodemographic factors, coercive measures used during involuntary admissions, and their potential impact on the mental health of healthcare professionals involved in these situations.

Study Origins

Cordero works with the Emergency Medical Services of the Valencian Community. The study arose from concerns about the impact involuntary admissions have on both patients and the healthcare professionals responsible for carrying them out.

Mental health crises, particularly suicidal crises, are among the situations most likely to result in involuntary hospitalization. In such cases, the actions of physicians, nurses, and other healthcare professionals can significantly influence outcomes. Depending on how the situation is managed, the results may range from successful crisis resolution to far more serious consequences.

Cordero said, “Caring for people experiencing a crisis also requires understanding what is happening emotionally to those providing that care. We need to ask what impact these experiences have on professionals and what emotional burden they carry with them after each intervention.”

According to Cordero, these situations are far more common than many individuals realize. “During a coordination shift, I may receive between one and three calls per hour involving individuals experiencing mental health crises,” he said. “Not all involve suicidal crises, but in many cases an involuntary admission must be considered to protect the individual’s health.”

Current legislation permits such measures when there is a risk to the individual or others. However, Cordero said that the greatest challenge extends beyond the legal framework.

“The difficult part is how both the patient and the professional experience the situation,” he said. “At times it is necessary to physically restrain a person or administer medication to achieve therapeutic sedation. These are situations for which we are not naturally prepared emotionally.”

Psychological Consequences

One of the study’s primary objectives was to examine the psychological consequences of these interventions. Researchers aim to better understand how involuntary admissions are experienced by both patients and healthcare professionals.

Previous studies have described symptoms consistent with posttraumatic stress in both groups following these events.

“Traditionally, certain traumatic experiences have been viewed as part of healthcare work, much as stress is accepted in other professions with high levels of emotional exposure,” Cordero said. “However, we are beginning to understand that these situations can leave significant psychological consequences and should not be considered normal or inevitable.”

Professional Support

The study, which began 2 years ago and is expected to conclude later this year, aims to generate evidence that can inform the development of more effective support strategies for emergency healthcare professionals.

“Our goal is not to judge healthcare professionals,” Cordero said. “We want to understand which factors shape these experiences so that we can develop training, support, and guidance programs that help professionals manage them appropriately.”

He believes that emergency workers should have access to tools that help them cope with the emotional impact of repeated exposure to critical incidents.

Without adequate support, accumulated emotional strain may affect both psychological well-being and quality of patient care.

“If professionals continue caring for patients while carrying unresolved trauma from previous experiences, it becomes much more difficult to face new situations under the best possible conditions,” Cordero said. “That is one of the issues we hope to address.”

Emotional Processing

Cordero noted that no clearly established strategy currently exists to support professionals who return home emotionally affected after particularly difficult interventions.

He also cautioned against relying exclusively on family members and friends to process these experiences.

“We now know that repeatedly sharing these experiences with family members can also create emotional distress for those who listen,” he said. “Without realizing it, we may cause collateral harm to the people closest to us.”

For that reason, he advocates the development of structured professional approaches to emotional processing and psychological support.

“It is important to develop a form of professional emotional processing that helps release accumulated tension, improve psychological well-being, and prevent the emotional burden of these experiences from spilling over into family life,” Cordero said.

Cordero serves as the study director and is a member of the SEMES. 

This article was translated from El Médico Interactivo.