Involuntary detention: do psychiatrists clinically justify continuing involuntary hospitalization?

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.