Why are patients discharged by review boards?

To identify why Review Boards revoked certificates for involuntary hospitalization.

The outcome of all applications for a Review Board hearing at 2 psychiatric hospitals in Ontario were recorded from the beginning of 1987 to the end of 1996. All cases where a certificate of involuntary hospitalization was revoked were identified. For each of these cases, the clinical record, including the Review Board's written reasons for its decision, was reviewed.

During the study period, 2644 patients applied for a review of their involuntary hospitalization. Only 42% of applications reached a hearing. Of these, 9% were revoked. Several recurring reasons for overturning certificates were identified. These included the physician relying too much on hearsay evidence, relatives supporting discharge at the hearings, and the patient clearly having recovered by the time the hearing took place.

Relatives or staff who observe dangerous behaviour should be encouraged to give evidence at hearings. The treatment team should take careful note of the views of patients' families and friends and review the patients' progress before hearings.