Policies and procedures for patient transfer from community clinics to emergency departments under the mental health act: Review and policy scan

Objective The objective of this commentary is to summarize the few findings from the scientific literature pertaining to humane mental health transfer practices in the province of Ontario as well as the broader Canadian and international context. These findings are juxtaposed with a policing policy scan concerning the Ontario and Canadian contexts. The practice of […]

Involuntary patient length-of-stay at a suburban emergency department

Background Patients who may be a danger to themselves or others often are placed on involuntary hold status in the Emergency Department (ED). Our primary objective was to determine if there are demographic and/or clinical variables of involuntary hold patients which were associated with an increased ED LOS. Methods Records of ED patients evaluated while […]

Suicide after evaluation for involuntary psychiatric commitment–Who gets them and what influences survival time?

Although involuntary psychiatric hospitalizations are associated with suicide risk, little is known about the relationship between evaluation for involuntary detention and suicide. We analyzed data on 10,082 suicides from 2000 to 2011 to examine demographics related to evaluation for detention and the association between demographics and evaluation dispositions on survival time. Evaluation preceded 11% of […]

Suicide and the State: the Ethics of Involuntary Hospitalization for Suicidal Patients

In this essay, the author first presents the argument that involuntary hospitalization is justified, & then presents the view that involuntary hospitalization is never justified. It is concluded that involuntary commitment is sometimes justified, but that the rules governing the institution need to be dramatically altered. (21 refs.) JA Contact us for a copy of […]

Suicide Among Men

In this editorial, the author asks what family physicians are doing to prevent suicide among men. The risks associated with 2 interventions, drug therapy & involuntary hospitalisation, are discussed. The editorial concludes by asking if family physicians cannot do more to prevent male suicide, pointing out that most individuals who die by suicide have seen […]

Suicide: Foucault, History and Truth

The author examines the historial & cultural forces that have influenced contemporary thought, practices & policy in relation to this serious public health problem. Drawing on the work of the French philosopher Michel Foucault, the book tells the story of how suicide has come to be seen as first & foremost a matter of psychiatric […]

EMS, Suicide, and the Out-of-Hospital DNR Order

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Is Hospitalization Useful for Suicidal Patients With Borderline Personality Disorder?

This article examines the value of hospitalization for chronically suicidal patients with borderline personality disorder. One in 10 of these patients will eventually die by suicide. However, this outcome is not readily predictable. Hospitalization is of unproven value for suicide prevention & can often produce negative effects. Day treatment is an evidence-based alternative to full […]

Chronic Suicidality and Borderline Personality

This article compares acute suicide ideation with chronic suicide ideation, specifically their different meanings, relationships with Axis I & Axis II disorders, intrapsychic functions, approaches to assessment, & interventions. The potential risks of acute hospitalization of the chronically suicidal borderline personality disorder patient are discussed as well as a longitudinal, multidimensional treatment strategy for the […]

Outcomes Following Appeal and Reversal of Civil Commitment

The authors tested whether adjudicated decisions over whether to uphold or rescind the detention of psychiatric patients had implications in subsequent patient morbidity. Consecutive patients applying to the Consent & Capacity Board in Ontario between January 2001-March 2007 were identified. A total of 3498 decisions were rendered for 2321 unique patients. Approximately 18% of involuntary […]

Did the Introduction of ‘Dangerousness’ and ‘Risk of Harm’ Criteria in Mental Health Laws Increase the Incidence of Suicide in the United States of America?

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Ethnic Variations in Pathways to Acute Care and Compulsory Detention for Women Experiencing a Mental Health Crisis

This study explored ethnic variations in compulsory detentions of women & the potential role of immediate pathways to admission & clinician-rated reasons for admission as mediators of these differences. All women admitted to an acute psychiatric inpatient ward or a women’s crisis house in 4 London boroughs during a 12-week period were included. Adjusting for […]

Preventing Suicide: a Resource for Police, Firefighters and Other First Line Responders

This booklet is written for police officers, firefighters, & other first-line responders who deal with people in psychological distress, including those who are suicidal. Topics covered include: suicide facts & figures; the contribution of police, firefighters, & other first-line responders to suicide prevention; helping someone who is suicidal; when a suicide attempt occurs; when a […]

Treatment of Psychiatric Patients With Impending Suicidal Risk

Assessment of suicide risk is a challenging task which includes a psychopathological evaluation, consideration of socio-demographic & clinical variables, history of previous suicide attempts, & analysis of the psychological context. A high index of suspicion helps to avoid possible pitfalls in the assessment of suicide risk. Individuals with imminent risk of suicide need immediate & […]

Improving the Quality of Suicide Risk Assessments in the Psychiatric Emergency Setting: Physician Documentation of Process Indicators

The quality of suicide risk assessments in the psychiatric emergency setting was evaluated by reviewing physician documentation of process indicators. Medical records of 145 patients involuntarily admitted were reviewed for 19 process indicators. Documentation that a process indicator was not met by a patient was included in the data. Patients were divided into 2 groups: […]

To Commit or not to Commit: the Psychiatry Resident as a Variable in Involuntary Commitment Decisions

This study examined whether psychiatry residents’ personal variables (such as age, gender, level of training, previous experience with patient suicide, or lawsuits) & their temperamental predispositions had an impact on their decisions to seek involuntary commitment. In a prospective pilot study, all psychiatry residents in Massachusetts were surveyed using a questionnaire that assessed their risk-taking […]

The Relationship of Suicide Death to Baker Act Examination, Client Characteristics and Service use Patterns (Agency for Health Care Administration Series 220-116)

This study aimed to provide a better understanding of the Medicaid funded services in Florida & the extent to which they were used by those who died by suicide, as well as an examination of service patterns & how they were related to this negative outcome. Lack of service use for those who were enrolled […]

Pros and Cons of Using the Mental Health act for Severe Eating Disorders in Adolescents

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Risk for Suicide Among Medicaid Beneficiaries

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Demand for Psychiatric Emergency Services and Immigration. Findings in a Spanish Hospital During the Year 2003

This study investigated differences among immigrants & natives regarding access & pathways to psychiatric care in a Spanish hospital, psychiatric admission rates, length of stay, continuity of care, & main diagnoses. Immigrants accounted for 13.0% of consultations to the psychiatric emergency room & 11.0% of admissions to the psychiatric hospitalization unit. Immigrants more often sought […]

Expediting Inpatient Admission When it’s Needed

This article reviews how hospital care may be expedited for patients who have psychiatric conditions or suicidal tendencies. Clinicians need to be clear about why admission is needed, to define the goals of hospitalization, & to measure the patient’s ability & willingness to follow doctors’ orders.

Changes to Mental Healthcare for Working age Adults: Impact of a Crisis Team and an Assertive Outreach Team

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Risk Factors for Suicide and Other Deaths Following Hospital Treated Self-Poisoning in Australia

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