Outcomes following appeal and reversal of civil commitment☆
Received 12 May 2009; accepted 16 October 2009. published online 19 November 2009.
Abstract
Objective
Psychiatric inpatients may be detained against their will, yet they still retain the right to apply for a hearing to challenge this detention. We tested whether adjudicated decisions over whether to uphold or rescind the detention have implications in subsequent patient morbidity.
Methods
Consecutive patients applying to the Consent and Capacity Board in Ontario between January 1, 2004, and March 31, 2007, were identified who had a hearing to challenge their involuntary detention. Population based databases provided information on subsequent deaths, hospitalization for a psychiatric illness, or emergency department visit for any reason.
Results
A total of 3498 decisions were rendered for 2321 unique psychiatric patients during the 39 month study period. Almost all patients (90%) had a prior psychiatric admission. Approximately 18% of involuntary detentions were rescinded with subsequent outcomes showing a greater likelihood of emergency department visits within 100 days of discharge in the group whose detention was rescinded compared to the group whose detention was upheld (46% vs. 36%, P=.003).
Conclusions
When an involuntary detention is rescinded patients have a high likelihood of subsequent utilization of emergency department services for suicide related symptoms but no large increase in risk of dying.
aDepartment of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
bDivision of General Internal Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
cClinical Epidemiology Unit, Sunnybrook Research Institute, Toronto, Canada
dInstitute for Clinical Evaluative Sciences in Ontario
Corresponding author. Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada M4N 3M5. Tel.: +1 416 480 4693; fax: +1 416 488 5318.
☆ Drs. Moss and Redelmeier report no competing interests.
ABSTRACT