- Design
- Nationwide registry cohort, Norway
- Population
- 321,708 adults aged 18 to 65, including 8,792 under compulsory care
- Primary outcome
- Mortality, self-harm, substance use, criminal justice and socioeconomic outcomes
- Effect
- Compulsory observation: self-harm or suicide 12% (95% CI 10 to 14) in women, 5.5% in men
A Norwegian nationwide registry study followed 321,708 adults who had specialist mental health contact in 2015 to 2016, plus general population comparators, through 2021 to 2023. It separated people under community treatment orders, compulsory hospitalisation, compulsory observation only, and voluntary care.
All compulsory groups had worse long-term health, justice and socioeconomic outcomes than voluntary patients. The compulsory observation group, people assessed under compulsion but not then admitted compulsorily, had the highest probability of self-harm or suicide: 12% in women (95% CI 10 to 14) and 5.5% in men. Suicide and other external causes made up 56% of classified deaths in that group, against 19% in the general population. People on community treatment orders had the highest rates of disability benefit, around 90%.
The finding most relevant to clinicians is that the person observed and then released is not a lower-risk patient. That group may get the least follow-up of all.
This describes prognosis, not the effect of compulsion; the groups differ in illness severity in ways the registry cannot fully capture.
- Treat a person released after compulsory observation as high risk for self-harm and substance misuse.
- Arrange follow-up after an observation period ends, even when admission was not needed.
- In men under compulsory care, screen for substance use disorder routinely.
- Do not assume all compulsory care patients share one prognosis.
Why it matters
The patient observed and let go may be the one most at risk.
Don't overread it
This describes outcomes by group; it does not show whether compulsory care helps or harms.
The statistics, in plain English
Adjusted probabilities here describe how often outcomes occurred in each group after accounting for birth year only. They are benchmarks for planning, not estimates of what compulsory care causes.
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