Inappropriate involuntary admissions to psychiatric hospitals
The original publication is available at http://www.samj.org.za
Background. In order to preserve scarce resources, treatment in tertiary psychiatric hospitals should be restricted to those whose treatment needs make admission to such hospitals essential. However, anecdotal evidence suggests that a number of patients involuntarily admitted to tertiary psychiatric hospitals are discharged within 7 days of admission. The aim of this study was to identify the legal and clinical reasons that contribute to this situation. Method. The first stage involved reviewing the mental health legislation and psycholegal literature. Thereafter we undertook a retrospective study of the records of the patients involuntarily admitted to Stikland Hospitar, a tertiary psychiatric hospital in the Western Cape. Treatment and security-related variables were compared for the ≤ 7 day and ≥ 8 day groups. Results. Eighteen per cent of involuntarily admitted patients were discharged within 7 days. The ≤ 7 day group differed significantly from the ≥ 8 day group in terms of gender, age, substance abuse history, diagnosis and previous admissions. There were more male patients, younger people, and individuals with a history of substance abuse in the ≤ 7 day group, while more patients in the ≥ 8 day group had a diagnosis of schizophrenia or bipolar mood disorder. Conclusions. This study of involuntarily admitted patients in a tertiary psychiatric hospital demonstrated that a small but notable group was discharged within 7 days of admission. The data do not allow us to determine exactly what caused this situation, and further research at primary and secondary level is necessary in order to clarify this.
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