Inappropriate involuntary admissions to psychiatric hospitals

Background. In order to preserve scarce resources, treatment in tertiary ps ychiatric hospitals should be restricted to those whose treatment needs mak e admission to such hospitals essential. However, anecdotal evidence sugges ts that a number of patients involuntarily admitted to tertiary psychiatric hospitals are discharged within 7 days of admission. The aim of this study was to identify the legal and clinical reasons that contribute to this sit uation. Method. The first stage involved reviewing the mental health legislation an d psycholegal literature. Thereafter we undertook a retrospective study of the records of the patients involuntarily admitted to Stikland Hospital, a tertiary psychiatric hospital in the Western Cape. Treatment and security-r elated variables were compared for the less than or equal to 7 day and grea ter than or equal to 8 day groups. Results. Eighteen per cent of involuntarily admitted patients were discharg ed within 7 days. The less than or equal to 7 day group differed significan tly from the greater than or equal to 8 day group in terms of gender, age, substance abuse history, diagnosis and previous admissions. There were more male patients, younger people, end individuals with a history of substance abuse in the less than or equal to 7 day group, while more patients in the greater than or equal to 8 day group had a diagnosis of schizophrenia or b ipolar mood disorder. Conclusions. This study of involuntarily admitted patients in a tertiary ps ychiatric hospital demonstrated that a small but notable group was discharg ed within 7 days of admission. The data do not allow us to determine exactl y what caused this situation, and further research at primary and secondary level is necessary in order to clarify this.