Differential use of admission status in a psychiatric emergency room.
J. Rabinowitz, M. Slyuzberg, I. Salamon and S. E. Dupler,
Bull. Amer. Acad. Psychiatry & the Law
23(4): 595-606, 1995.
The goal of this study is to understand how different admission statuses of varying degrees of
restrictiveness (informal, voluntary, emergency admission, and involuntary admission on medical
certification) are used in the psychiatric emergency room. The study included 656 consecutively
admitted patients from a psychiatric emergency room over 28 months. Data were analyzed
univariately and using two discriminant function models. Only six (0.9%) patients were informal
admissions. Voluntary admissions (24.9%, n = 163) tended to be for patients with affective
disorders, those who were self-referred, suicidal risks, those who had a marital or family problem,
and those who were over age 60. Nonvoluntary admissions (74.2%) tended to be for patients with
schizophreniform symptoms and those referred by police or court. Involuntary admission on medical
certification (53.2%, n = 349) tended to be for patients who were family referred, younger than 20
years old, had social interpersonal nonfamily stressors, were suicidal risks, were or had been married,
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 diagnosis of psychoactive substance abuse, having previous outpatient treatment, and having been
referred by emergency service. The major difference between involuntary admissions and voluntary
was that the former were more often actively psychotic or referred by police or court. The major
difference between emergency admission and involuntary admission on medical certification seemed
to be that patients with a more available support system, whose primary diagnoses was not substance
abuse and who were suicidal, were preferred for involuntary admission on medical certification.