While the ethics of involuntary admission for psychiatric inpatient care is widely contested, the practice is legally permissible across most jurisdictions. In many countries, laws governing the use of involuntary admission set out core criteria under which involuntary admission is permitted; these parameters broadly related to either risk of harm to self or others, need for treatment, or both. In South Africa, the use of involuntary admission is governed by the Mental Health Care Act no. 17 of 2002 (MHCA 2002), which sets out clear criteria to direct mental healthcare practitioners' decision-making and delineates a process by which decision-making should occur. However, recent research suggests that, in practice, the process of decision-making differs from the procedure prescribed in the MHCA 2002. To further explore how decision-making for involuntary admission occurs in practice, we interviewed 20 mental healthcare practitioners, all with extensive experience of making involuntary admission decisions, working in district, regional, and tertiary hospitals across five provinces. We also interviewed four mental health advocates to explore patient-centered insights. Our analysis suggests that the final decision to involuntarily admit individuals for a 72-h assessment period under the MHCA 2002 was preceded by a series of ‘micro-decisions’ made by a range of stakeholders: 1) the family's or police's decision to bring the individual into hospital, 2) a triage nurse's decision to prioritise the individual along a mental healthcare pathway in the emergency centre, and 3) a medical officer's decision to sedate the individual. Practitioners reported that the outcomes of each of these ‘micro-decisions’ informed aspects of their final decision to admit an individual involuntarily. Our analysis therefore suggests that the final decision to admit involuntarily cannot be understood in isolation because practitioners draw on a range of additional information, gleaned from these prior ‘micro-decisions’, to inform the final decision to admit.

虽然精神病住院治疗的非自愿入院伦理受到广泛质疑，但这种做法在大多数司法管辖区都是法律允许的。在许多国家，管理非自愿入院使用的法律规定了允许非自愿入院的核心标准；这些参数广泛地与伤害自己或他人的风险、治疗需求或两者相关。在南非，非自愿入院的使用受《精神卫生保健法》第 1 号的管辖。2002 年第 17 号法令（MHCA 2002），它制定了明确的标准来指导精神保健从业者的决策，并描述了决策应该发生的过程。然而，最近的研究表明，在实践中，决策过程与 MHCA 2002 中规定的程序不同。为了进一步探讨非自愿入院的决策在实践中是如何发生的，我们采访了 20 名精神保健从业者，他们都在做出非自愿入院决定方面拥有丰富的经验，在五个省的地区、地区和三级医院工作。我们还采访了四位心理健康倡导者，以探索以患者为中心的见解。我们的分析表明，在根据 MHCA 2002 做出 72 小时评估期非自愿接纳个人的最终决定之前，一系列利益相关者做出了一系列“微决定”：1) 家庭或警察决定将个人进入医院，2) 分诊护士决定在急救中心的精神保健途径中优先考虑个人，以及 3) 医务人员决定对个人进行镇静。从业者报告说，这些“微决定”中的每一个的结果都会影响他们最终决定非自愿入院的各个方面。因此，我们的分析表明，不能孤立地理解非自愿承认的最终决定，因为从业者利用从这些先前的“微决定”中收集的一系列额外信息来告知最终承认决定。