Psychiatric hospitalization decision making by CMHC staff.

The decision to recommend hospitalization for patients with psychiatric illness is often made on the basis of unknown reliability and validity. The purpose of this study was to examine the characteristics and reliability of self-reported psychiatric hospitalization decision making among staff at a Community Mental Health Center. Foremost among the results, the conditions that staff consider to be appropriate indicators of hospitalization show only modest reliability. Kappa interrater reliabilities of .10 to .60 persist across different staff types and different patient problems. Results from hypothetical cases support a micro-certainty, macro-uncertainty hypothesis: staff are highly confident in the appropriateness of their treatment recommendations, but the recommendations across staff are variable. The results empirically demonstrate the need to improve the reliability of the hospitalization decision, and to work towards valid outcomes-based hospitalization criteria.