Outcomes following appeal and reversal of civil commitment.
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 Approximately 18% of involuntary detentions were rescinded with subsequent outcomes showing a greater likelihood of emergency department visits within 100 days of discharge in the group whose detention was rescinded compared to the group whose detention was upheld (46% vs. 36%, P=.003).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When an involuntary detention is rescinded patients have a high likelihood of subsequent utilization of emergency department services for suicide related symptoms but no large increase in risk of dying.
Moss
Jay H
JH
Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada M4N 3M5. jay.moss@sunnybrook.ca
Redelmeier
Donald A
DA
D000328:Adult; D003134:Commitment of Persons with Psychiatric Disorders / Q000331:legislation & jurisprudence*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000145:classification; D009864:Ontario; D017063:Outcome Assessment, Health Care; D018570:Risk Assessment