A retrospective analysis of cases between 2022-2024 evaluated for compulsory hospitalization under article 432 of the Turkish civil code

This study aimed to investigate the sociodemographic characteristics and clinical conditions of cases evaluated under Article 432 of the Turkish Civil Code (TMK), which constitutes the legal framework for compulsory hospitalization and involuntary treatment in Turkey, as assessed by the Departments of Forensic Medicine and Psychiatry. In addition, the study sought to identify the problems encountered during hospitalization processes and to propose recommendations to ensure the effective implementation of the practice. Data from 164 cases referred to the Department of Forensic Medicine, Faculty of Medicine, Süleyman Demirel University (Isparta), between 2022 and 2024 for evaluation and reporting regarding compulsory hospitalization were retrospectively reviewed from departmental archives and patient files. The majority of cases were individuals aged 18–64 years (92,7%) and male (70,7%), with a mean age of 36,2 years. Although the number of cases evaluated increased over the years, the proportion of cases in which compulsory hospitalization was deemed necessary decreased. Overall, compulsory hospitalization was recommended in 63,4% of cases; the most frequent diagnoses were substance use disorder (40,4%), schizophrenia spectrum and other psychotic disorders (29,8%), and bipolar disorder (20,2%). The median waiting time from decision to actual hospitalization was 35 days (range: 0–252), while the median length of stay for hospitalized patients was 28 days (range: 0–153). In 8,7% of cases for whom compulsory hospitalization was decided, hospitalization was never realized. As in many other provinces in Turkey, the absence of a local facility in Isparta authorized to admit patients under compulsory hospitalization resulted in prolonged delays until a suitable center could be found, and in some cases, hospitalization was never carried out despite the decision. Considering the negative implications for both patient treatment and public safety, it is recommended that healthcare centers conducting compulsory hospitalization evaluations establish a rapid access system for "high-priority cases," develop temporary observation units or forensic intermediate services, and implement a centrally managed "Bed Coordination System" in collaboration with the Ministry of Health to streamline referral and admission processes. Furthermore, the establishment of a "Post-Compulsory Treatment Follow-up and Rehabilitation Program" is considered essential to improve treatment adherence and prevent repeated admissions.