Patients refused admission to a psychiatric hospital.

Psychiatric hospitals are under pressure to reduce admissions as a way of lowering census. In a state hospital that established a screening team to refer inappropriate applicants elsewhere, a study was undertaken to compare applicants admitted for treatment with those refused admission. Although 72 percent of those who requested admission were admitted, more applicants from the hospital's own county than from other counties in the catchment area were referred elsewhere. Further, many more applicants for voluntary admission were referred elsewhere than were applicants referred by other agencies or referred in a committed-but-refusable status. The data suggest that clinicians who are encouraged to refuse admission to some applicants tend to refuse voluntary applicants. If screening for public hospitalization tends to lead to refusal of individuals who request services and admission of those who resist them, an unfortunate catch-22 situation has developed.