Jay H Moss1, Donald A Redelmeier. 1. Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada M4N 3M5. jay.moss@sunnybrook.ca
Abstract
OBJECTIVE: Psychiatric inpatients may be detained against their will, yet they still retain the right to apply for a hearing to challenge this detention. We tested whether adjudicated decisions over whether to uphold or rescind the detention have implications in subsequent patient morbidity. METHODS: Consecutive patients applying to the Consent and Capacity Board in Ontario between January 1, 2004, and March 31, 2007, were identified who had a hearing to challenge their involuntary detention. Population based databases provided information on subsequent deaths, hospitalization for a psychiatric illness, or emergency department visit for any reason. RESULTS: A total of 3498 decisions were rendered for 2321 unique psychiatric patients during the 39 month study period. Almost all patients (90%) had a prior psychiatric admission. Approximately 18% of involuntary detentions were rescinded with subsequent outcomes showing a greater likelihood of emergency department visits within 100 days of discharge in the group whose detention was rescinded compared to the group whose detention was upheld (46% vs. 36%, P=.003). CONCLUSIONS: When an involuntary detention is rescinded patients have a high likelihood of subsequent utilization of emergency department services for suicide related symptoms but no large increase in risk of dying. Copyright 2010 Elsevier Inc. All rights reserved.
OBJECTIVE:Psychiatric inpatients may be detained against their will, yet they still retain the right to apply for a hearing to challenge this detention. We tested whether adjudicated decisions over whether to uphold or rescind the detention have implications in subsequent patient morbidity. METHODS: Consecutive patients applying to the Consent and Capacity Board in Ontario between January 1, 2004, and March 31, 2007, were identified who had a hearing to challenge their involuntary detention. Population based databases provided information on subsequent deaths, hospitalization for a psychiatric illness, or emergency department visit for any reason. RESULTS: A total of 3498 decisions were rendered for 2321 unique psychiatricpatients during the 39 month study period. Almost all patients (90%) had a prior psychiatric admission. Approximately 18% of involuntary detentions were rescinded with subsequent outcomes showing a greater likelihood of emergency department visits within 100 days of discharge in the group whose detention was rescinded compared to the group whose detention was upheld (46% vs. 36%, P=.003). CONCLUSIONS: When an involuntary detention is rescinded patients have a high likelihood of subsequent utilization of emergency department services for suicide related symptoms but no large increase in risk of dying. Copyright 2010 Elsevier Inc. All rights reserved.