Rooming-in: an alternative to involuntary detention.

Abstract

To provide, via 'rooming-in', a local, less coercive and less frightening alternative to involuntary detention. Rooming in is the voluntary participation of so-called 'confidants', who may be chosen family members or trusted friends, in the management of acute, severe psychiatric disturbance by their providing a 24 hour vigil with the patient in a single, safe hospital room. There were 73 admissions to the rooming-in program at the Manning Base Hospital, Taree, New South Wales (NSW), Australia between 5 August 1986 and 21 September 1992. During the same period 78 patients were remitted from the hospital on an involuntary basis to urban detention centres: 'scheduled' under the NSW Mental Health Act. Demographic and diagnostic characteristics of the two populations, both of whom met identical criteria for involuntary detention, are compared in this retrospective, case report study. These two groups constituted only 6% of total psychiatric consults carried out at the hospital over the same 6 year period and those roomed-in represented only 12% of the psychiatric admissions. A quality assurance study evaluated the acceptability of the program. The scheduled patients were more likely to be single, of no fixed abode and without a local family. They were more likely to have a schizophrenic disorder, compounded by polysubstance abuse, than a mood disorder. The average inpatient stay for those roomed-in was 10 days. Seventy per cent of confidants were required for 4 days or less. The rooming-in program was valued highly by nursing staff, patients and their families. A search of the world literature would suggest that rooming-in, as a model of care, is unique, at least in the developed world. It allows some seriously disturbed patients to be provided with a local and less restrictive general hospital alternative.