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Involuntary Psychiatric Hospitalization: How Patient Characteristics Affect Decision-Making

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Abstract

Emergency department (ED) psychiatrists face the consequential decision to pursue involuntary inpatient psychiatric admission. Research on the relationship between patient characteristics and the decision to pursue involuntary psychiatric admission is limited. Using data from 2017 to 2018 at an urban Los Angeles hospital, we used generalized linear mixed effects models to compare patients who were involuntarily admitted to inpatient psychiatry to patients who were discharged from the ED. Of 2,448 patients included in the study, 1,217 (49.7%) were involuntarily admitted to inpatient psychiatry and 1,231 (50.3%) were discharged. After controlling for sociodemographic characteristics, admitted patients were more likely to have been brought in by police, have had an organized suicide plan or recent attempt, physical signs of harm, psychosis, depression or hopelessness, lack social support, have diagnoses of schizophrenia or bipolar disorder, and be administered injectable psychotropic medications. Stimulant use, a diagnosis of anxiety or developmental disorders, and recent medical ED utilization were associated with discharge. Psychiatrists pursued involuntarily psychiatric hospitalization based on factors potentially indicative of dangerousness, leaving patients, particularly those with recent substance use, without immediate access to treatment. Policies should focus on increasing follow up to high quality, voluntary outpatient mental health care.

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Data Availability

The data from this study was from the Cedars Sinai Medical Center.

References

  1. Hedman LC, Petrila J, Fisher WH, Swanson JW, Dingman DA, Burris S. State laws on emergency holds for mental health stabilization. Psychiatr Serv. 2016;67:529–35.

    Article  Google Scholar 

  2. Levenson JL. Psychiatric commitment and involuntary hospitalization: an ethical perspective. Psychiatric Q. 1986.

  3. Simpson SA, Monroe C. Implementing and evaluating a standard of care for clinical evaluations in emergency psychiatry. J Emerg Med. 2018;55:522–29. e2.

  4. Rüsch N, Müller M, Lay B, Corrigan PW, Zahn R, Schönenberger T, Bleiker M, Lengler S, Blank C, Rössler W. Emotional reactions to involuntary psychiatric hospitalization and stigma-related stress among people with mental illness. Eur Arch Psychiatry Clin Neurosci. 2014;264:35–43.

    Article  Google Scholar 

  5. Lawrence RE, Perez-Coste MM, Bailey JL, DeSilva RB, Dixon LB. Coercion and the inpatient treatment alliance. Psychiatr Serv. 2019;70:1110–5.

    Article  Google Scholar 

  6. Lidz CW, Hoge SK, Gardner W, Bennett NS, Monahan J, Mulvey EP, Roth LH. Perceived coercion in mental hospital admission: pressures and process. Arch Gen Psychiatry. 1995;52:1034–9.

    Article  CAS  Google Scholar 

  7. Zhu JM, Singhal A, Hsia RY. Emergency department length-of-stay for psychiatric visits was significantly longer than for nonpsychiatric visits, 2002–11. Health Aff. 2016;35:1698–706.

    Article  Google Scholar 

  8. Nicks B, Manthey D. The impact of psychiatric patient boarding in emergency departments. Emerg Med Int. 2012; 2012.

  9. Pinals DA. Liability and patient suicide. Focus. 2019;17:349–54.

    Article  Google Scholar 

  10. Fakhoury W, Priebe S. Deinstitutionalization and reinstitutionalization: major changes in the provision of mental healthcare. Psychiatry. 2007;6:313–6.

    Article  Google Scholar 

  11. Kroll DS, Karno J, Mullen B, Shah SB, Pallin DJ, Gitlin DF. Clinical severity alone does not determine disposition decisions for patients in the emergency department with suicide risk. Psychosomatics. 2018;59:388–93.

    Article  Google Scholar 

  12. Bouch J, Marshall JJ. Suicide risk: structured professional judgement. Adv Psychiatr Treat. 2005;11:84–91.

    Article  Google Scholar 

  13. Anderson ES, Lippert S, Newberry J, Bernstein E, Alter HJ, Wang NE. Addressing social determinants of health from the emergency department through social emergency medicine. West J Emerg Med. 2016;17:487.

    Article  Google Scholar 

  14. Bureau USC. United States Census Bureau ZIP Code Tabulation Areas; 2010.

  15. Patterson WM, Dohn HH, Bird J, Patterson GA. Evaluation of suicidal patients: the SAD PERSONS scale. Psychosomatics. 1983;24:343–9.

    Article  CAS  Google Scholar 

  16. Benjamini Y, Hochberg Y. Controlling the false discovery rate: a practical and powerful approach to multiple testing. J Roy Stat Soc: Ser B (Methodol). 1995;57:289–300.

    Google Scholar 

  17. McGarvey EL, Leon-Verdin M, Wanchek TN, Bonnie RJ. Decisions to initiate involuntary commitment: the role of intensive community services and other factors. Psychiatr Serv. 2013;64:120–6.

    Article  Google Scholar 

  18. Ellila HT, Sourander A, Välimäki M, Warne T, Kaivosoja M. The involuntary treatment of adolescent psychiatric inpatients—a nation-wide survey from Finland. J Adolesc. 2008;31:407–19.

    Article  Google Scholar 

  19. Preti A, Rucci P, Santone G, Picardi A, Miglio R, Bracco R, Norcio B, de Girolamo G. Patterns of admission to acute psychiatric in-patient facilities: a national survey in Italy. Psychol Med. 2009;39:485–96.

    Article  CAS  Google Scholar 

  20. Zeppegno P, Airoldi P, Manzetti E, Panella M, Renna M, Torre E. Involuntary psychiatric admissions: a retrospective study of 460 cases. Eur J Psychiatry. 2005;19:133–43.

    Article  Google Scholar 

  21. Baca-García E, Diaz-Sastre C, Resa EG, Blasco H, Conesa DB, Saiz-Ruiz J, De Leon J. Variables associated with hospitalization decisions by emergency psychiatrists after a patient’s suicide attempt. Psychiatr Serv. 2004;55:792–7.

    Article  Google Scholar 

  22. Giampieri E, Ratti A, Beretta A, Mattavelli C, Ferrarini E, Pruneri C, Carta I. Determinants of hospitalization from psychiatric ER from S. Gerardo hospital in Monza: epidemiological cross-sectional study. Epidemiology and Psychiatric Sciences. 2002;11:266–76.

    Article  Google Scholar 

  23. Riecher A, Rössler W, Löffler W, Fätkenheuer B. Factors influencing compulsory admission of psychiatric patients. Psychol Med. 1991;21:197–208.

    Article  CAS  Google Scholar 

  24. Rosenfield S. Race differences in involuntary hospitalization: psychiatric vs. labeling perspectives. J Health Soc Behav. 1984;14–23.

  25. Unick GJ, Kessell E, Woodard EK, Leary M, Dilley JW, Shumway M. Factors affecting psychiatric inpatient hospitalization from a psychiatric emergency service. Gen Hosp Psychiatry. 2011;33:618–25.

    Article  Google Scholar 

  26. Braslow JT, Messac L. Medicalization and demedicalization—a gravely disabled homeless man with psychiatric illness. N Engl J Med. 2018;379:1885–8.

    Article  Google Scholar 

  27. Hillard JR, Slomowitz M, Deddens J. Determinants of emergency psychiatric admission for adolescents and adults. Am J Psychiatry. 1988;145:1416.

    Article  CAS  Google Scholar 

  28. Dazzi F, Picardi A, Orso L, Biondi M. Predictors of inpatient psychiatric admission in patients presenting to the emergency department: the role of dimensional assessment. Gen Hosp Psychiatry. 2015;37:587–94.

    Article  Google Scholar 

  29. Olfson M, Ascher-Svanum H, Faries DE, Marcus SC. Predicting psychiatric hospital admission among adults with schizophrenia. Psychiatr Serv. 2011;62:1138–45.

    Article  Google Scholar 

  30. Rabinowitz J, Slyuzberg M, Salamon I, Dupler S, Kennedy RS, Steinmuller R. A method for understanding admission decision making in a psychiatric emergency room. Psychiatr Serv. 1995.

  31. Segal SP, Laurie TA, Segal MJ. Factors in the use of coercive retention in civil commitment evaluations in psychiatric emergency services. Psychiatr Serv. 2001;52:514–20.

    Article  CAS  Google Scholar 

  32. Way BB, Banks S. Clinical factors related to admission and release decisions in psychiatric emergency services. Psychiatr Serv. 2001;52:214–8.

    Article  CAS  Google Scholar 

  33. Goldberg JF, Ernst CL, Bird S. Predicting hospitalization versus discharge of suicidal patients presenting to a psychiatric emergency service. Psychiatr Serv. 2007;58:561–5.

    Article  Google Scholar 

  34. Moeller KE, Lee KC, Kissack JC. Urine drug screening: practical guide for clinicians. In: Mayo Clinic Proceedings. Elsevier; 2008. p. 66–76

  35. De Wit H. Impulsivity as a determinant and consequence of drug use: a review of underlying processes. Addict Biol. 2009;14:22–31.

    Article  Google Scholar 

  36. Haggård-Grann U, Hallqvist J, Långström N, Möller J. The role of alcohol and drugs in triggering criminal violence: a case-crossover study. Addiction. 2006;101:100–8.

    Article  Google Scholar 

  37. Breslow RE, Klinger BI, Erickson BJ. Acute intoxication and substance abuse among patients presenting to a psychiatric emergency service. Gen Hosp Psychiatry. 1996;18:183–91.

    Article  CAS  Google Scholar 

  38. Curran C, Byrappa N, McBride A. Stimulant psychosis: systematic review. Br J Psychiatry. 2004;185:196–204.

    Article  Google Scholar 

  39. Van Boekel LC, Brouwers EP, Van Weeghel J, Garretsen HF. Stigma among health professionals towards patients with substance use disorders and its consequences for healthcare delivery: systematic review. Drug Alcohol Depend. 2013;131:23–35.

    Article  Google Scholar 

  40. Barker LC, Sunderji N, Kurdyak P, Stergiopoulos V, Gonzalez A, Kopp A, Vigod SN. Urgent outpatient care following mental health ED visits: a population-based study. Psychiatr Serv. 2020;appi. ps. 201900466.

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Acknowledgements

This research was supported by the National Clinicians Scholars Program at UCLA and Cedars Sinai Medical Center. Each of the listed authors meets each of the three authorship requirements as stated in the Uniform Requirements for Manuscripts Submitted to Biomedical Journals.

Funding

Support for this research came from the National Clinicians Scholars Program at the University of California Los Angeles and Cedars Sinai Medical Center.

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Authors and Affiliations

  1. National Clinician Scholars Program At UCLA Funded By Cedars-Sinai Medical Center and the David Geffen School of Medicine at UCLA, Los Angeles, CA, USA

    Ish P. Bhalla

  2. Cedars-Sinai Medical Center, Los Angeles, CA, USA

    Ish P. Bhalla, Keith Siegel, Monika Chaudhry, Sam Torbati, Teryl Nuckols & Itai Danovitch

  3. David Geffen School of Medicine At UCLA, Department of General Internal Medicine, Los Angeles, CA, USA

    Ish P. Bhalla & Ning Li

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  1. Ish P. Bhalla
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Correspondence to Ish P. Bhalla.

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Research Involving Human Participants and Animals

This study was reviewed and approved by the Cedars-Sinai Medical Center Institutional Review Board.

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A waiver of informed consent was obtained and no patient identifiers were used in this study.

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The authors declare that they have no conflict of interest.

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Bhalla, I.P., Siegel, K., Chaudhry, M. et al. Involuntary Psychiatric Hospitalization: How Patient Characteristics Affect Decision-Making. Psychiatr Q 93, 297–310 (2022). https://doi.org/10.1007/s11126-021-09939-2

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  • DOI: https://doi.org/10.1007/s11126-021-09939-2

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