Investigation of the criteria for involuntary admission to a general hospital.

The case records of all patients admitted involuntarily to the psychiatric unit of a teaching general hospital between May 1, 1985, and Apr. 30, 1986, were examined to assess the criteria used for admission in relation to several patient characteristics. Of the 55 patients 42 were admitted under the terms of form 1 (application for psychiatric assessment) and 13 under the terms of form 3 (certificate of involuntary admission). All of the former patients and 70% of the latter were admitted under the criteria for dangerousness; however, one-third of these patients had failed to show any evidence of violent or suicidal behaviour. Most of the patients admitted because of their dangerousness had a nonpsychotic disorder, whereas 83% of those admitted because of lack of competence had a psychotic disorder. These findings are discussed in relation to the criteria for involuntary admission in the 1980 Mental Health Act of Ontario. The difficulties encountered in the admission process by physicians appear to be the result of a lack of clinical considerations and a predominant emphasis on dangerousness.