P-675 - Compulsory hospital admission - use or abuse?

Abstract

Introduction According to the Portuguese Mental Health Law (PMHL), compulsory admission (CA) may be used whenever someone bears a “severe psychic anomaly” which is causing, or may cause, danger to his own juridical rights or to those of others, given that the subject refuses adequate treatment. A psychiatric evaluation, in emergency settings, might be ordered by a judge through a warrant and a report must be sent to the court about the clinical need of CA. Objectives Assess the appropriate use of PMLH in what refers to its legal and clinical aspects in the emergency room. We explored social-demographic and clinical variables of the subjects submitted to CA and studied the relation between the patients subjected to psychiatric evaluation by court order and those were actually compulsory admitted. Methods We studied retrospectively, the clinical files of 4537 patients who attended the psychiatric emergency of the Coimbra University Hospital between January and June, 2010. Results 1,3% of all patients were compulsory admitted, two thirds of which were male, half were unemployed or retired. 1,7% were subjected to psychiatric evaluation by court order, about 50% weren’t admitted compulsory. The majority of warrants were issued because of aggressive behaviour or behavioural changes. The most frequent diagnosis in CA were schizophrenia and delusional disorders. Conclusions Understanding CA patterns helps to identify possible misuses of the law and may serve to recognize subgroups of patients in need of specific interventions to prevent the use of judicial processes concerning psychiatric patients.