Predictors of voluntary and compulsory admissions after psychiatric emergency consultation in youth

Pety So,Jurgen Cornelis,Marion Lommerse,Robert R J M Vermeiren,Marianne C Kasius,André I Wierdsma,Cornelis L Mulder

doi:10.1007/s00787-020-01558-9

Abstract

As hospital beds are scarce, and emergency admissions to a psychiatric ward are major life-events for children and adolescents, it is essential to have insight into the decision-making process that leads to them. To identify potentially modifiable factors, we, therefore, studied the contextual and clinical characteristics associated with the voluntary and compulsory emergency admission of minors. We used registry data (2008–2017) on 1194 outpatient emergencies involving children aged 6–18 who had been referred to the mobile psychiatric emergency service in two city areas in The Netherlands. Demographic and contextual factors were collected, as well as clinical characteristics including diagnoses, psychiatric history, Global Assessment of Functioning (GAF), and the Severity of Psychiatric Illness (SPI) scale. Logistic regression analyses were used to identify factors that predict voluntary or compulsory admission. Of 1194 consultations, 227 (19.0%) resulted in an admission, with 137 patients (11.5%) being admitted voluntarily and 90 (7.5%) compulsorily. Independently of legal status, the following characteristics were associated with admission: severity of psychiatric symptoms, consultation outside the patient’s home, and high levels of family disruption. Relative to voluntary admission, compulsory admission was associated with more severe psychiatric problems, higher suicide risk, and prior emergency compulsory admission. Two potentially modifiable factors were associated with psychiatric emergency admission: the place where patients were seen for consultation, and the presence of family problems. Psychiatric emergency admissions may be reduced if, whenever possible, minors are seen in their homes and if a system-oriented approach is used.

Highlights

Even though hospitalization it is a major life event, it is sometimes necessary, especially to stabilize and treat young people in a psychiatric crisis
Because most studies are based on data from children and adolescents in crisis that present to emergency departments (EDs), we aimed to identify factors upon which the outreaching emergency services in The Netherlands base their decisions on the emergency admission of minors
The Medical Ethics Committee confirmed that the Medical Research Involving Human Subjects Act (Dutch acronym: WMO) did not apply to this study, and that no informed consent was required

Summary

Introduction

Even though hospitalization it is a major life event, it is sometimes necessary, especially to stabilize and treat young people in a psychiatric crisis. While the overall prevalence of mental health conditions in youth has remained relatively stable [1], many recent studies have reported an increase in psychiatric emergencies in children and adolescents. Such increase has been noted in the United States [2,3,4,5], Canada [6,7,8], and Europe [9,10,11]. Most countries have reduced the number of child and adolescent psychiatric inpatient beds [12,13,14] Together with this reduction in inpatient beds, the increase in psychiatric emergencies makes it important to identify factors leading children and adolescents in an emergency situation to be admitted to a psychiatric hospital. Possible modifiable factors associated with emergency admission in youth should be identified, as these factors may be a target for preventing these admissions

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