DIFFERENTIAL USE OF ADMISSION STATUS IN A PSYCHIATRIC EMERGENCY ROOM

The goal of this study is to understand how different admission status es of varying degrees of restrictiveness (informal, voluntary, emergen cy admission, and involuntary admission on medical certification) are used in the psychiatric emergency room. The study included 656 consecu tively admitted patients from a psychiatric emergency room over 28 mon ths. Data were analyzed univariately and using two discriminant functi on models. Only six (0.9%) patients were informal admissions. Voluntar y admissions (24.9%, n = 163) tended to be for patients with affective disorders, those who were self-referred, suicidal risks, those who ha d a marital or family problem, and those who were over age 60. Nonvolu ntary admissions (74.2%) tended to be for patients with schizophrenifo rm symptoms and those referred by police or court. Involuntary admissi on on medical certification (53.2%, n = 349) tended to be for patients who were family referred, younger than 20 years old, had social inter personal nonfamily stressors, were suicidal risks, were or had been ma rried, had organic psychotic disorder, history of violence, and manic episode or schizophrenia. Emergency admission patients (21%, n = 138) were characterized by being between 40 to 50 years old,having a diagno sis of psychoactive substance abuse, having previous outpatient treatm ent, and having been referred by emergency service. The major differen ce between involuntary admissions and voluntary was that the former we re more often actively psychotic or referred by police or court. The m ajor difference between emergency admission and involuntary admission on medical certification seemed to be that patients with a more availa ble support system, whose primary diagnoses was not substance abuse an d who were suicidal, were preferred for involuntary admission on medic al certification.