"Involuntary" and "Voluntary" in Psychiatric, Behavioral, and Mental Health Services: A Scoping Review of Definitions.

Abstract

The meaning of (in)voluntary in the context of psychiatric, behavioral, and mental health services in the United States lacks shared understanding despite widespread use, such as in "involuntary treatment," "involuntary hospitalization," and "voluntary patient." A pre-registered scoping review was conducted to describe how U.S.-based healthcare professionals explicitly define (in)voluntary when referring to psychiatric, behavioral, and mental health concepts. Nine databases and nine organization/government websites were searched. Eligibility criteria included English availability, U.S.-based healthcare author(s), and an explicit definition of (in)voluntary. Extracted data included study characteristics and (in)voluntary term(s) with definitions. Open coding was used for the (in)voluntary-associated definition. Meaning categories were created by grouping codes. A total of 29,313 citations were screened for a final 162 sources, containing 203 definitions. Evidence sources (years 1966-2023) were most frequently research articles (33%), review articles (24%), and books (20%) with authorship including persons with an M.D./D.O. (70%) and/or Ph.D. (51%). The most common definition words were order, coercion, against/opposed to a patient's will/wishes, consent, force, and adhere. Meaning categories were external pressure, civil rights, individual agency, competence and capacity, and ethics. Involuntary definitions more commonly characterized the patient as actively against an intervention (23%), rather than without active agreement (11%). Some definitions included a legal (62%) and/or ethical dimension (33%). Two-thirds of sources used at least one additional (in)voluntary term in the publication without defining it. Because there exists a range of competing definitions for the term (in)voluntary, authors who use this descriptor clearly are recommended to explain their meaning.