1. Introduction
Various laws and regulations has long been formulated to protect the social rights of individuals in society including mentally-ill patients [1]. Involuntary hospital admission refers to the hospitalization of patients against their will. Involuntary hospital admission of mentally-ill patients is usually done to protect them and to protect the society against their abnormal behaviours [2]. In most societies, jurisdictions allow involuntary hospital admission of a mentally-ill patient, although the definition of mental illness varies in the jurisdiction of different countries in terms of the period of admission before independent examination, involuntary hospitalization, and the role of scientific decision-making supported by judicial authorities [4]. In the jurisdictions of different countries, almost the same procedures are used for the admission, detention and compulsory treatment of the mentally ill, which demonstrates compliance with international standards and the integration of human rights principles [5]. The purpose of this study is to investigate the referral cases from judicial authorities to Shafa Psychiatric Hospital in Rasht, Iran in 2018 to help solve the problem of involuntary hospital admission.
2. Methods
This is a descriptive cross-sectional study. The study population included the medical records of all patients referred to Shafa Hospital by judicial authorities in 2018. For sampling, the census method was used. The inclusion criteria was availability of all cases admitted by a court letter and the exclusion criteria was incomplete information in medical records. All eligible files were first confirmed using the Hospital Information System (HIS) and then the files were delivered based their numbers from the hospital archives department and the information including demographic characteristics (age, gender, place of residence, marital status, education, occupation), reasons for referral (psychiatric symptoms, risk of self-harm, risk of harm to others, need for treatment), criminal history, history of psychiatric disorders, history of hospitalization in a psychiatric hospital,  and type of psychiatric disorder were extracted from medical records and court letters were extracted using a checklist. After collecting the information, they were entered in IBM SPSS v.21 software, and analyzed using the inferential statics, including t-test and chi-square test.
3. Results
In this study, most of cases was for patients who were male (96.8%), and single (57.6%) living in urban areas (78.8%). In 217 referral cases, the most common reason for referral was “dispatch and hospitalization” (44.9%) followed by “the need for treatment” (29.6%). Most of referral cases (94.9%) had a history of psychiatric disorders, while the percentage of cases without a history of psychiatric disorders was only 5.1%. The most common reported history of psychiatric disorders was "schizophrenia" (40.4%) followed by "substance abuse" (27.1%). Of 217 cases, 251 had mentioned the type of psychiatric diagnoses (some with more than one diagnosed type; e.g. both personality disorder and major depressive disorder). The most common type of diagnosed psychiatric disorder was "schizophrenia" (37.5%) followed by "substance use disorder" (21.9%) and "bipolar disorder" (15.5%). The results of Chi-square test showed a significant relationship between the history of psychiatric disorder and criminal history (X2= 10.336, P=0.001), but the history of psychiatric disorder had no significant relationship with age, education, and employment status in referral cases.
4. Conclusion
 Based on our findings, although the reasons for the majority of involuntary hospital admissions in the study hospital were the dispatch & hospitalization and the need for treatment, and most of patients had psychiatric disorders, in some cases, the reason for referral was inappropriate. Since hospitalization imposes additional financial and psychological burden on the individual, despite the legal requirements for involuntary hospital admissions, the patients need to be visited by a psychiatrist prior to hospitalization; if there was no need for hospitalization, it should be informed to the judicial authorities and the mere existence of a court letter cannot be a criterion for involuntary hospital admission and give the patient the title of mentally-ill person. This indicates the need for more coordination between the judicial authorities and the medical centers in admitting these patients to the hospitals.

Ethical Considerations
Compliance with ethical guidelines
This study was approved by the Ethics Committee of the Guilan University of Medical Sciences (Code: IR.GUMS.REC.1398.260). Ethical principles are fully observed in this article. 

Funding
This study was extracted from the thesis of second author. This research has not received any financial support from profit and non-profit organizations. 

Authors' contributions
Conceptualization, visualization, project administration, and resources: All authors; Methodology and formal analysis: Mahnaz Fallahi-Khesht; Original draft preparation: Somayeh Shokrgozar, Adele Isanazar, Maryam Zavarmousavi; Editing & review, Investigation and supervision: Somayeh Shokrgozar, Adele Isanazar; Data collection: Mohadeseh Varasteh. 

Conflicts of interest
The authors declared no conflict of interest. 

Acknowledgements
The authors would like to thank the HIS manager in Shafa Hospital for cooperation in collecting information.


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