FACTORS ASSOCIATED WITH INVOLUNTARY RETURN TO A PSYCHIATRIC EMERGENCYSERVICE WITHIN 12 MONTHS

Objective: This study examined patient characteristics and other facto rs that contributed to the involuntary return of patients to a psychia tric emergency service within 12 months of an initial evaluation in th e service. The findings were used to consider whether the pressure to limit duration of hospital stays under managed care contributed to the patients' return to the emergency service, Methods: Structured observ ations of evaluations of 417 patients admitted to the psychiatric emer gency service were completed at seven county general hospitals in Cali fornia. Twelve months after the initial evaluation, mental health and criminal justice records were reviewed for evidence of the patients' r eturn for emergency psychiatric evaluation at any of the seven hospita ls. Factors associated with patients' return to the psychiatric emerge ncy service were evaluated using multivariate modeling. Results: Of th e 417 patients initially evaluated, 121, or 29 percent, were involunta rily returned to the psychiatric emergency service within 12 months. T he likelihood of involuntary return was increased by a psychotic diagn osis and indications of dangerousness at the initial evaluation. Havin g insurance also increased the likelihood of involuntary return, Concl usions: The patient's initial condition in the psychiatric emergency s ervice was found to be the best predictor of involuntary return. Brief hospitalization-an average of six days-after the evaluation did not h ave a significant prophylactic effect, perhaps because the reduced len gth of inpatient stay in the managed care environment did not allow ad equate resolution of the patient's clinical condition.