Abstract
To elucidate disparities in clinical and legal documentation for patients admitted involuntarily to a county psychiatric hospital in Texas. The study sample comprised of 89 randomly selected patients, involuntarily hospitalized to our facility in September 2011. All patients met criteria for involuntary detention based on the legal documents filed by admitting psychiatrists. Electronic medical records were reviewed to assess if the clinical documentation from the same date when legal documents were filed; demonstrated criteria for involuntary detention (harm to self, harm to others, inability to care for self). A logistic regression model was used to assess the predictors of concordance between legal and clinical documentation of involuntary detention criteria. Of 89, 6 patients were made voluntary, while two were discharged within 24 h, thus removed from the analysis pool. Of 81, 31(38.2 %) patients lacked sufficient clinical documentation on medical records required for involuntary hospitalization. Patients, for whom detention was justified in clinical notes, were more likely to have single marital status, longer duration of hospitalization and they were more likely to undergo commitment for further inpatient mental health treatment. Our study found that involuntary detention of many patients based on the legal documents filed by admitting psychiatrists was not justified by the clinical documentation. This indicates that appropriate standards are not maintained when completing the medical certificates for involuntary detention. Maintaining appropriate standards may reduce the need for involuntary hospitalization, increase patient autonomy, and reduce resource utilization.
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References
Texas Department of State health Services, t.e.: Texas Laws Relating to Mental Health Sec.573.022, 2011.
Testa M and West SG: Civil commitment in the United States. Psychiatry 7(10):30–40, 2010.
Commitment, N.C.f.S.C.N.T.F.o.G.f.I.C.: Guidelines for involuntary civil commitment. Mental and physical disability law reporter 10(5):409–514, 1986.
Katsakou C and Priebe S: Outcomes of involuntary hospital admission—a review. Acta psychiatrica Scandinavica 114(4):232–241, 2006.
Moss JH and Redelmeier DA: Outcomes following appeal and reversal of civil commitment. General hospital psychiatry 32(1):94–98, 2010.
Brooks RA: Psychiatrists’ opinions about involuntary civil commitment: results of a national survey. The journal of the American Academy of Psychiatry and the Law 35(2):219–228, 2007.
Appelbaum PS and Hamm RM: Decision to seek commitment. Psychiatric decision making in a legal context. Archives of general psychiatry 39(4):447–451, 1982.
Schwartz HI, Appelbaum PS, and Kaplan RD: Clinical judgments in the decision to commit. Psychiatric discretion and the law. Archives of general psychiatry 41(8):811–815, 1984.
Bagby RM, et al.: Decision making in psychiatric civil commitment: an experimental analysis. The American journal of psychiatry 148(1):28–33, 1991.
Lidz CW, et al.: Commitment: the consistency of clinicians and the use of legal standards. The American journal of psychiatry 146(2):176-181, 1989.
Cohen J: Statistical power analysis for the behavioral sciences (2nd Ed.). Hillsdale, Lawrence Erlbaum Associates, 1988.
McGarvey EL, et al.: Decisions to initiate involuntary commitment: the role of intensive community services and other factors. Psychiatric services 64(2):120–126, 2013.
Segal SP, Laurie TA, and Segal MJ: Factors in the use of coercive retention in civil commitment evaluations in psychiatric emergency services. Psychiatric services 52(4):514–520, 2001.
Services, T.D.o.S.h.: Texas Laws Relating to Mental Health Sec.571.019 18th edition, 2011.
Kallert TW, Glockner M, and Schutzwohl M: Involuntary vs. voluntary hospital admission. A systematic literature review on outcome diversity. European archives of psychiatry and clinical neuroscience 258(4):195–209, 2008.
Nicholson RA: Correlates of commitment status in psychiatric patients. Psychological bulletin 100(2):241–50, 1986.
Bloom JD: Civil commitment is disappearing in Oregon. The journal of the American Academy of Psychiatry and the Law 34(4):534–537, 2006.
Institute of Medicine (US), Committee on Quality of Health Care in America: Crossing the quality chasm: a new health system for the the 21st century. Washington, National Academy Press, 2001.
Sattar SP, et al.: To commit or not to commit: the psychiatry resident as a variable in involuntary commitment decisions. Academic psychiatry 30(3):191–195, 2006.
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Hashmi, A., Shad, M., Rhoades, H.M. et al. Involuntary Detention: Do Psychiatrists Clinically Justify Continuing Involuntary Hospitalization?. Psychiatr Q 85, 285–293 (2014). https://doi.org/10.1007/s11126-014-9289-3
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DOI: https://doi.org/10.1007/s11126-014-9289-3