Factors influencing the decision for further hospitalisation or in-patient crisis intervention at the psychiatric emergency department of civil hospitals in Belgium

Abstract

Objective: This research attempted to determine which variables were associated with the decision to provide further treatment of psychiatric emergency referrals in three general hospitals. First, in-patient and out-patient treatment were compared. Secondly, a new treatment alternative, i.e. a short-term crisis intervention, was compared to immediate hospitalisation. Methods : A cross-sectional design was used to compare the different subgroups. Results: The pilot hospitals shared a set of significantly discriminating variables: a professional source of referral, involuntary presentation at the emergency department, previous hospitalisations, an axis I diagnosis 'psychotic disorder' or 'mood disorder' and a high judgement of reliability of given information all increased the likelihood of further in-patient treatment. The second analysis revealed that the short-term 'crisis unit' alternative was used more often for specific problem groups such as attempted suicides or groups of younger patients and in case of referrals out of office hours. Conclusions: Despite individual differences in decision making, clinicians at the psychiatric emergency departments in Belgium share an unspoken but stable decision algorithm. The introduction of a psychiatric crisis unit within the emergency department seems to improve the quality of services offered.