Negotiating psychiatric hospitalizations within restrictive admissions criteria

A study of 189 consecutive psychiatric dispositions from the emergency service of an urban university hospital illustrates the difficulty that emergency psychiatric clinicians face when trying to find a receiving institution for a patient requiring hospitalization. All 18 of the receiving systems used by the service had restrictive admissions criteria that affected the admissions of specific patients, among them presence or absence of health insurance, voluntary or involuntary status, willingness of the family to participate in treatment, and patient's sex and age. Four case reports taken from the 189 dispositions demonstrate how clinicians must present patients to admitting staff in a manner that convinces an institution to admit them. The consequences of this practice are discussed, as are potential solutions to disposition difficulties.