title: Factors associated with disallowance of compulsory mental healthcare referrals.
abstract: OBJECTIVE
  Norwegian studies report that a substantial amount of referrals for compulsory mental health care are disallowed at specialist assessment, at a rate that varies with referring agent. Knowledge on factors associated with disallowance could improve the practice of compulsory mental health care. This study aims to examine such factors, placing particular emphasis on the impact of referring agents.
  
  
  METHODS
  This study utilized data from the prospective, longitudinal cohort study 'Suicidality in Psychiatric Emergency Admissions' conducted at a Norwegian psychiatric emergency unit which served approximately 400 000 inhabitants. Data on referral, admission and patient characteristics were retrieved on compulsory admissions conducted between 1 May 2005 and 30 April 2008. Bivariate and logistic regression analyses and structural multilevel modelling were performed.
  
  
  RESULTS
  Among 2813 compulsory admissions, 764 were disallowed. Low competence in the referring agent, high GAF S score, observed alcohol or drug intoxication, reported suicide risk, and the presence of neurotic, stress-related and somatoform disorders, personality disorders and other non-specified diagnoses were associated with above average disallowance frequency. Non-Norwegian ethnicity and schizophrenia spectrum disorders were associated with below average disallowance rates.
  
  
  CONCLUSIONS
  Among several factors associated with disallowance, low symptom load was the strongest, whilst referring agent competence modestly affected disallowance rate.
authors.affiliation: Uni Research Health, National Centre for Emergency Primary Health Care, Bergen, Norway.
authors.forename: N L D
authors.initials: NL
authors.lastname: Fuglseth
authors.affiliation: Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
authors.forename: R
authors.initials: R
authors.lastname: Gjestad
authors.affiliation: Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
authors.forename: L
authors.initials: L
authors.lastname: Mellesdal
authors.affiliation: Uni Research Health, National Centre for Emergency Primary Health Care, Bergen, Norway.
authors.forename: S
authors.initials: S
authors.lastname: Hunskaar
authors.affiliation: Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.|Department of Clinical Medicine and Global mental health research group, GMHRG, Centre for International Health, Faculty of Medicine and Dentistry, University of Bergen, Bergen, Norway.
authors.forename: K J
authors.initials: KJ
authors.lastname: Oedegaard
authors.affiliation: Uni Research Health, National Centre for Emergency Primary Health Care, Bergen, Norway.
authors.forename: I H
authors.initials: IH
authors.lastname: Johansen
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003134:Commitment of Persons with Psychiatric Disorders / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway; D010343:Patient Admission / Q000706:statistics & numerical data*; D011446:Prospective Studies; D011567:Psychiatric Department, Hospital / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D013405:Suicide / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: commitment of mentally ill; delivery of health care; emergencies; psychiatry; referral and consultation