Predictors and Outcomes of Detention Under Psychiatric Holding Powers

This study aimed to characterize the use of emergency psychiatric holding powers in Ireland, investigate predictors of their initiation, and describe clinical outcomes among patients subject to holds.

This retrospective case-control study characterized and compared all voluntarily admitted patients who were either detained under holding powers (N=167 cases involving 162 unique patients) or not subject to holding powers (N=334 control patients) during a stay in one of two psychiatric hospitals in Dublin (January 2018-December 2020). These groups were examined from admission through 1 year after discharge.

The use of holding powers was rare (2% of voluntary admissions during the study). Patients in both groups were similar, with no significant sociodemographic differences. The case group was rated as having more severe illness at admission (p<0.001). Multivariable analyses demonstrated that detention was more likely in the presence of impaired insight (OR=4.14), psychotic symptoms (OR=7.56), and suicidal ideation (OR=2.58) at admission and with a diagnosis of bipolar disorder (OR=2.50). Mean length of stay was longer for case group (vs. control group) patients (81.37 vs. 45.74 days, z=-7.42, p<0.001), but illness improvement ratings at discharge did not significantly differ between the groups, nor did readmission rates for the year after discharge.

Voluntarily admitted patients who became subject to holding powers had more severe illness at admission than did those without holds. The likelihood of experiencing detention increased with impaired insight, psychotic symptoms, and suicidal ideation at admission. However, the results suggested that treatment outcomes for both groups were similar.