Abstract
This chapter reviews the concept of AMA discharges as it is applied to patients hospitalized in a psychiatric facility including the management of concomitant mental illness, determining criteria for commitment, and unique differences in this population. The epidemiology of AMA discharges from inpatient psychiatric hospitals is surveyed with attention to both patient and provider factors. The chapter then reviews the political and philosophical history of voluntary psychiatric admission in the United States. Current debates regarding the role of decision-making capacity, informed consent, and coercion in voluntary admission are analyzed as background to a consideration of the liability concerns and clinical implications of psychiatrists confronted with patient-initiated requests for discharge. Based on the literature and analysis, the chapter concludes with recommendations for preventive ethics strategies and best practices to reduce the frequency and improve the quality of AMA discharges from psychiatry for both patients and practitioners.
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References
Molnar G, Keitner L, Swindall L. Medicolegal problems of elopement from psychiatric units. J Forensic Sci. 1985;30(1):44–9.
Pages KP, Russo JE, Wingerson DK, Ries RK, Roy-Byrne PP, Cowley DS. Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital. Psychiatr Serv. 1998;49(9):1187–92.
Blader JC. Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Arch Gen Psychiatry. 2011;68(12):1276–83.
Haupt DN, Ehrlich SM. The impact of a new state commitment law on psychiatric patient careers. Hosp Community Psychiatry. 1980;31(11):745–51.
Babalola O, Gormez V, Alwan NA, Johnstone P, Sampson S. Length of hospitalisation for people with severe mental illness. Cochrane Database Syst Rev. 2014;1:CD000384.
Chandrasena R. Premature discharges: a comparative study. Can J Psychiatr. 1987;32(4):259–63.
Alfandre DJ. “I’m going home”: discharges against medical advice. Mayo Clin Proc. 2009;84(3):255–60.
LaWall JS, Jones R. Discharges from a ward against medical advice: search for a profile. Hosp Community Psychiatry. 1980;31(6):415–6.
Senior N, Kibbee P. Can we predict the patient who leaves against medical advice: the search for a method. Psychiatr Hosp. 1986;17(1):33–6.
Brook M, Hilty DM, Liu W, Hu R, Frye MA. Discharge against medical advice from inpatient psychiatric treatment: a literature review. Psychiatr Serv. 2006;57(8):1192–8.
Yong TY, Fok JS, Hakendorf P, Ben-Tovim D, Thompson CH, Li JY. Characteristics and outcomes of discharges against medical advice among hospitalised patients. Intern Med J. 2013;43(7):798–802.
Beck NC, Shekim W, Gilbert F, Fraps C. A cross-validation of factors predictive of AMA discharge. Hosp Community Psychiatry. 1983;34(1):69–70.
Hayat AA, Ahmed MM, Minhas FA. Patients leaving against medical advice: an inpatient psychiatric hospital-based study. J Coll Physicians Surg Pak. 2013;23(5):342–6.
Akhtar S, Helfrich J, Mestayer RF. AMA discharge from a psychiatric inpatient unit. Int J Soc Psychiatry. 1981;27(2):143–50.
Dalrymple AJ, Fata M. Cross-validating factors associated with discharges against medical advice. Can J Psychiatr. 1993;38(4):285–9.
McGlashan TH, Heinssen RK. Hospital discharge status and long-term outcome for patients with schizophrenia, schizoaffective disorder, borderline personality disorder, and unipolar affective disorder. Arch Gen Psychiatry. 1988;45(4):363–8.
Valevski A, Zalsman G, Tsafrir S, Lipschitz-Elhawi R, Weizman A, Shohat T. Rate of readmission and mortality risks of schizophrenia patients who were discharged against medical advice. Eur Psychiatry. 2012;27(7):496–9.
Sclar DA, Robison LM. Hospital admission for schizophrenia and discharge against medical advice in the United States. Prim Care Companion J Clin Psychiatry. 2010;12(2): e1–e6.
Appelbaum PS, Gutheil TG. Legal issues in emergency psychiatry. In: Appelbaum PS, Gutheil TG, editors. Clinical handbook of psychiatry & the law. Philadelphia: Lippincott, Williams & WIlkins; 2007.
Garakani A, Shalenberg E, Burstin SC, Weintraub Brendel R, Appel JM. Voluntary psychiatric hospitalization and patient-driven requests for discharge: a statutory review and analysis of implications for the capacity to consent to voluntary hospitalization. Harv Rev Psychiatry. 2014;22(4):241–9.
Appelbaum PS, Gutheil TG. Legal issues in inpatient psychiatry. In: Appelbaum PS, Gutheil TG, editors. Clinical handbook of psychiatry & the law. Philadelphia: Lippincott, Williams & Wilkins; 2007.
Kaufman AR, Way B. North Carolina resident psychiatrists knowledge of the commitment statutes: do they stray from the legal standard in the hypothetical application of involuntary commitment criteria? Psychiatry Q. 2010;81(4):363–7.
Greenwald AF, Bartemeier LH. Psychiatric discharges against medical advice. Arch Gen Psychiatry. 1963;8:117–9.
Appelbaum PS. Clinical practice. Assessment of patients’ competence to consent to treatment. N Engl J Med. 2007;357(18):1834–40.
Zinermon v. Burch. 1990, U.S. p. 113.
Appelbaum PS. Voluntary hospitalization and due process: the dilemma of Zinermon v. Burch Hosp Comm Psychiatr. 1990;41(10):1059–60.
O’Donoghue B, Roche E, Shannon S, Lyne J, Madigan K, Feeney L. Perceived coercion in voluntary hospital admission. Psychiatry Res. 2014;215(1):120–6.
Stone DH. The benefits of voluntary inpatient psychiatric hospitalization: myth or reality? Boston Univ Public Interest Law J. 1999;9(1):25–52.
Lidz CW, Hoge SK, Gardner W, Bennett NS, Monahan J, Mulvey EP, et al. Perceived coercion in mental hospital admission. Pressures and process. Arch Gen Psychiatr. 1995;52(12):1034–9.
Gerbasi JB, Simon RI. Patients’ rights and psychiatrists’ duties: discharging patients against medical advice. Harv Rev Psychiatry. 2003;11(6):333–43.
Devitt PJ, Devitt AC, Dewan M. An examination of whether discharging patients against medical advice protects physicians from malpractice charges. Psychiatr Serv. 2000;51(7):899–902.
Solbrig v. the United States of America, in Lexis 2201. 1995, U.S. Dist.
Kelly v. the United States of America and John Doe, John Roe, & John Shoe, in Lexis 2201. 1987, Civil Action 86–2864.
Devitt PJ, Devitt AC, Dewan M. Does identifying a discharge as “against medical advice” confer legal protection? J Fam Pract. 2000;49(3):224–7.
Tarasoff v. Regents of University of California 1976, Cal.3d. p. 425.
Knoll JL. The psychiatrist’s duty to protect. CNS Spectr. 2015;20(3):215–22.
Dwyer J, Shih A. The ethics of tailoring the patient’s chart [see comments]. Psychiatr Serv. 1998;49(10):1309–12.
Simon RI. Psychiatrists’ duties in discharging sicker and potentially violent inpatients in the managed care era. Psychiatr Serv. 1998;49(1):62–7.
Targum SD, Capodanno AE, Hoffman HA, Foudraine C. An intervention to reduce the rate of hospital discharges against medical advice. Am J Psychiatry. 1982;139(5):657–9.
Louks J, Mason J, Backus F. AMA discharges: prediction and treatment outcome. Hosp Community Psychiatry. 1989;40(3):299–301.
Ti L, Ti L. Leaving the hospital against medical advice among people who use illicit drugs: a systematic review. Am J Public Health. 2015;105(12):e53–9.
Chandrasena R, Miller WC. Discharges AMA and AWOL: a new “revolving door syndrome”. Psychiatr J Univ Ott. 1988;13(3):154–7.
Swanson JW, McCrary SV, Swartz MS, Elbogen EB, Van Dorn RA. Superseding psychiatric advance directives: ethical and legal considerations. J Am Acad Psychiatry Law. 2006;34(3):385–94.
Brock DW. A proposal for the use of advance directives in the treatment of incompetent mentally ill persons. Bioethics. 1993;7(2–3):247–56.
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Geppert, C. (2018). Against Medical Advice Discharges: Considerations in the Psychiatric Population. In: Alfandre, D. (eds) Against‐Medical‐Advice Discharges from the Hospital. Springer, Cham. https://doi.org/10.1007/978-3-319-75130-6_11
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