Psychiatrists and Public Health Authorities: Different Perspectives about Compulsory Admission in a Psychiatric Unit

Introduction: Compulsive admissions of severe mentally ill patients are controversial but often necessary procedures. The Public Health Authorities are responsible for issuing a warrant that results in the compulsory detention and hospital admission of these patients for an urgent psychiatric evaluation. Objectives: This study aims to characterize the compulsory patients brought to the Emergency Room with a warrant issued by the local Public Health Authorities, and to study the correlation between the issuance of the warrant and the subsequent compulsory hospital admission. Methods: Retrospective observational study, in the period between January, 1st, 2012 and June, 30th, 2013 from the data included in warrants issued by the Public Health Authorities in the district of Evora. Results: The data of 57 patients brought to the Emergency Room with warrants issued by Public Health Authorities for urgent psychiatric evaluation was analyzed. After psychiatric evaluation, 36,8% had no mental illness that justified compulsory hospital admission. The analysis of Public Health Authority warrants identified four general reasons for demanding an urgent psychiatric evaluation. Clinical information was lacking in 74% of all revised warrants. Discussion and Conclusion: This study verified that more than one third of all the warrants were not followed by compulsory hospital admission to an acute psychiatric unit. Based on these findings it is relevant to question the lack of congruence between the criteria used by the Public Health Authorities and Psychiatrists to justify the need for compulsory admission in a psychiatric unit.