Citation

Kavanagh A, Donnelly J, Dunne N, Maher T, Nichol M, Creedon J. Int. J. Ment. Health Nurs. 2020; 29(4): 716-724.

Copyright

(Copyright © 2020, Australian College of Mental Health Nurses Inc., Publisher John Wiley and Sons)

DOI

10.1111/inm.12706

PMID

32134182

Abstract

In the Irish mental healthcare system, voluntarily admitted service users can request to leave hospital at any time. Following engagement with treating clinicians, service users remain as voluntary inpatients, are discharged, discharge themselves against medical advice, or are detained under legislation for the purposes of assessment. While detention conflicts with the principle of autonomy and a human rights-based approach, premature discharge is often associated with negative outcomes including reduced time to readmission, poorer quality of life, increased costs, and suicide. This study is a retrospective review of clinical records to identify factors associated with requests for premature discharge. Considerations of clinicians making the decision to detain the person or to support them through the discharge against medical advice process were also elucidated. Data were collected from clinical records of service users who requested discharge and were subsequently discharged against medical advice or detained involuntarily. Discharge against medical advice represented 3.5% of all discharges. The most frequent reasons for requests for discharge against medical advice were dissatisfaction with treatment, lack of engagement due to addiction, and leaving without notifying staff. Requests for discharge against medical advice frequently occurred out of hours, and nurses were the clinicians most likely to receive such requests.

Language: en

Keywords

Humans; mental health; suicide; Retrospective Studies; Hospitalization; Quality of Life; Patient Discharge; Inpatients; Treatment Refusal; Involuntary commitment; patient readmission; patient discharge