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Why are patients discharged by review boards?
R L O'Reilly1, W Komer, S Dunbar
1Research and Education London/St Thomas Psychiatric Hospital, Ontario. roreilly@julian.uwo.ca
Summary
Review Boards revoked involuntary hospitalization certificates when physicians relied on hearsay, families supported discharge, or patients recovered. Encouraging family input and reviewing patient progress can improve hospitalization decisions.
Area of Science:
- Psychiatry
- Mental Health Law
- Clinical Psychology
Background:
- Involuntary hospitalization is a critical intervention in psychiatric care.
- Review Boards play a crucial role in overseeing involuntary hospitalization decisions.
- Understanding revocation reasons is vital for improving patient rights and care.
Purpose of the Study:
- To determine the primary reasons for the revocation of involuntary hospitalization certificates by Review Boards.
- To analyze factors contributing to successful appeals against involuntary psychiatric confinement.
Main Methods:
- A retrospective review of all applications for Review Board hearings at two Ontario psychiatric hospitals (1987-1996).
- Identification and detailed analysis of cases where certificates for involuntary hospitalization were revoked.
- Examination of clinical records and Review Board"s written justifications for revocations.
Main Results:
- Out of 2644 applications for review, only 42% reached a hearing, with 9% of these resulting in certificate revocation.
- Key reasons for revocation included physicians over-reliance on hearsay evidence.
- Family support for patient discharge and evidence of patient recovery by the hearing date were significant factors.
Conclusions:
- Clinicians should prioritize direct evidence over hearsay when initiating involuntary hospitalization.
- Incorporating family and friend perspectives is crucial in Review Board assessments.
- Regular reassessment of patient progress prior to hearings can inform hospitalization decisions.