Against Medical Advice Discharges: Considerations in the Psychiatric Population

Chapter

Abstract

This chapter reviews the concept of AMA discharges as it is applied to patients hospitalized in a psychiatric facility including the management of concomitant mental illness, determining criteria for commitment, and unique differences in this population. The epidemiology of AMA discharges from inpatient psychiatric hospitals is surveyed with attention to both patient and provider factors. The chapter then reviews the political and philosophical history of voluntary psychiatric admission in the United States. Current debates regarding the role of decision-making capacity, informed consent, and coercion in voluntary admission are analyzed as background to a consideration of the liability concerns and clinical implications of psychiatrists confronted with patient-initiated requests for discharge. Based on the literature and analysis, the chapter concludes with recommendations for preventive ethics strategies and best practices to reduce the frequency and improve the quality of AMA discharges from psychiatry for both patients and practitioners.

Keywords

Against medical advice Discharge Psychiatry Inpatient Informed consent Coercion Decision-making capacity Legal Coercion Patient rights Voluntary admission 

References

  1. 1.
    Molnar G, Keitner L, Swindall L. Medicolegal problems of elopement from psychiatric units. J Forensic Sci. 1985;30(1):44–9.CrossRefGoogle Scholar
  2. 2.
    Pages KP, Russo JE, Wingerson DK, Ries RK, Roy-Byrne PP, Cowley DS. Predictors and outcome of discharge against medical advice from the psychiatric units of a general hospital. Psychiatr Serv. 1998;49(9):1187–92.CrossRefGoogle Scholar
  3. 3.
    Blader JC. Acute inpatient care for psychiatric disorders in the United States, 1996 through 2007. Arch Gen Psychiatry. 2011;68(12):1276–83.CrossRefGoogle Scholar
  4. 4.
    Haupt DN, Ehrlich SM. The impact of a new state commitment law on psychiatric patient careers. Hosp Community Psychiatry. 1980;31(11):745–51.PubMedGoogle Scholar
  5. 5.
    Babalola O, Gormez V, Alwan NA, Johnstone P, Sampson S. Length of hospitalisation for people with severe mental illness. Cochrane Database Syst Rev. 2014;1:CD000384.Google Scholar
  6. 6.
    Chandrasena R. Premature discharges: a comparative study. Can J Psychiatr. 1987;32(4):259–63.CrossRefGoogle Scholar
  7. 7.
    Alfandre DJ. “I’m going home”: discharges against medical advice. Mayo Clin Proc. 2009;84(3):255–60.CrossRefGoogle Scholar
  8. 8.
    LaWall JS, Jones R. Discharges from a ward against medical advice: search for a profile. Hosp Community Psychiatry. 1980;31(6):415–6.PubMedGoogle Scholar
  9. 9.
    Senior N, Kibbee P. Can we predict the patient who leaves against medical advice: the search for a method. Psychiatr Hosp. 1986;17(1):33–6.PubMedGoogle Scholar
  10. 10.
    Brook M, Hilty DM, Liu W, Hu R, Frye MA. Discharge against medical advice from inpatient psychiatric treatment: a literature review. Psychiatr Serv. 2006;57(8):1192–8.CrossRefGoogle Scholar
  11. 11.
    Yong TY, Fok JS, Hakendorf P, Ben-Tovim D, Thompson CH, Li JY. Characteristics and outcomes of discharges against medical advice among hospitalised patients. Intern Med J. 2013;43(7):798–802.CrossRefGoogle Scholar
  12. 12.
    Beck NC, Shekim W, Gilbert F, Fraps C. A cross-validation of factors predictive of AMA discharge. Hosp Community Psychiatry. 1983;34(1):69–70.PubMedGoogle Scholar
  13. 13.
    Hayat AA, Ahmed MM, Minhas FA. Patients leaving against medical advice: an inpatient psychiatric hospital-based study. J Coll Physicians Surg Pak. 2013;23(5):342–6.PubMedGoogle Scholar
  14. 14.
    Akhtar S, Helfrich J, Mestayer RF. AMA discharge from a psychiatric inpatient unit. Int J Soc Psychiatry. 1981;27(2):143–50.CrossRefGoogle Scholar
  15. 15.
    Dalrymple AJ, Fata M. Cross-validating factors associated with discharges against medical advice. Can J Psychiatr. 1993;38(4):285–9.CrossRefGoogle Scholar
  16. 16.
    McGlashan TH, Heinssen RK. Hospital discharge status and long-term outcome for patients with schizophrenia, schizoaffective disorder, borderline personality disorder, and unipolar affective disorder. Arch Gen Psychiatry. 1988;45(4):363–8.CrossRefGoogle Scholar
  17. 17.
    Valevski A, Zalsman G, Tsafrir S, Lipschitz-Elhawi R, Weizman A, Shohat T. Rate of readmission and mortality risks of schizophrenia patients who were discharged against medical advice. Eur Psychiatry. 2012;27(7):496–9.CrossRefGoogle Scholar
  18. 18.
    Sclar DA, Robison LM. Hospital admission for schizophrenia and discharge against medical advice in the United States. Prim Care Companion J Clin Psychiatry. 2010;12(2): e1–e6.Google Scholar
  19. 19.
    Appelbaum PS, Gutheil TG. Legal issues in emergency psychiatry. In: Appelbaum PS, Gutheil TG, editors. Clinical handbook of psychiatry & the law. Philadelphia: Lippincott, Williams & WIlkins; 2007.Google Scholar
  20. 20.
    Garakani A, Shalenberg E, Burstin SC, Weintraub Brendel R, Appel JM. Voluntary psychiatric hospitalization and patient-driven requests for discharge: a statutory review and analysis of implications for the capacity to consent to voluntary hospitalization. Harv Rev Psychiatry. 2014;22(4):241–9.CrossRefGoogle Scholar
  21. 21.
    Appelbaum PS, Gutheil TG. Legal issues in inpatient psychiatry. In: Appelbaum PS, Gutheil TG, editors. Clinical handbook of psychiatry & the law. Philadelphia: Lippincott, Williams & Wilkins; 2007.Google Scholar
  22. 22.
    Kaufman AR, Way B. North Carolina resident psychiatrists knowledge of the commitment statutes: do they stray from the legal standard in the hypothetical application of involuntary commitment criteria? Psychiatry Q. 2010;81(4):363–7.CrossRefGoogle Scholar
  23. 23.
    Greenwald AF, Bartemeier LH. Psychiatric discharges against medical advice. Arch Gen Psychiatry. 1963;8:117–9.CrossRefGoogle Scholar
  24. 24.
    Appelbaum PS. Clinical practice. Assessment of patients’ competence to consent to treatment. N Engl J Med. 2007;357(18):1834–40.CrossRefGoogle Scholar
  25. 25.
    Zinermon v. Burch. 1990, U.S. p. 113.Google Scholar
  26. 26.
    Appelbaum PS. Voluntary hospitalization and due process: the dilemma of Zinermon v. Burch Hosp Comm Psychiatr. 1990;41(10):1059–60.Google Scholar
  27. 27.
    O’Donoghue B, Roche E, Shannon S, Lyne J, Madigan K, Feeney L. Perceived coercion in voluntary hospital admission. Psychiatry Res. 2014;215(1):120–6.CrossRefGoogle Scholar
  28. 28.
    Stone DH. The benefits of voluntary inpatient psychiatric hospitalization: myth or reality? Boston Univ Public Interest Law J. 1999;9(1):25–52.PubMedGoogle Scholar
  29. 29.
    Lidz CW, Hoge SK, Gardner W, Bennett NS, Monahan J, Mulvey EP, et al. Perceived coercion in mental hospital admission. Pressures and process. Arch Gen Psychiatr. 1995;52(12):1034–9.CrossRefGoogle Scholar
  30. 30.
    Gerbasi JB, Simon RI. Patients’ rights and psychiatrists’ duties: discharging patients against medical advice. Harv Rev Psychiatry. 2003;11(6):333–43.PubMedGoogle Scholar
  31. 31.
    Devitt PJ, Devitt AC, Dewan M. An examination of whether discharging patients against medical advice protects physicians from malpractice charges. Psychiatr Serv. 2000;51(7):899–902.CrossRefGoogle Scholar
  32. 32.
    Solbrig v. the United States of America, in Lexis 2201. 1995, U.S. Dist.Google Scholar
  33. 33.
    Kelly v. the United States of America and John Doe, John Roe, & John Shoe, in Lexis 2201. 1987, Civil Action 86–2864.Google Scholar
  34. 34.
    Devitt PJ, Devitt AC, Dewan M. Does identifying a discharge as “against medical advice” confer legal protection? J Fam Pract. 2000;49(3):224–7.PubMedGoogle Scholar
  35. 35.
    Tarasoff v. Regents of University of California 1976, Cal.3d. p. 425.Google Scholar
  36. 36.
    Knoll JL. The psychiatrist’s duty to protect. CNS Spectr. 2015;20(3):215–22.CrossRefGoogle Scholar
  37. 37.
    Dwyer J, Shih A. The ethics of tailoring the patient’s chart [see comments]. Psychiatr Serv. 1998;49(10):1309–12.CrossRefGoogle Scholar
  38. 38.
    Simon RI. Psychiatrists’ duties in discharging sicker and potentially violent inpatients in the managed care era. Psychiatr Serv. 1998;49(1):62–7.CrossRefGoogle Scholar
  39. 39.
    Targum SD, Capodanno AE, Hoffman HA, Foudraine C. An intervention to reduce the rate of hospital discharges against medical advice. Am J Psychiatry. 1982;139(5):657–9.CrossRefGoogle Scholar
  40. 40.
    Louks J, Mason J, Backus F. AMA discharges: prediction and treatment outcome. Hosp Community Psychiatry. 1989;40(3):299–301.PubMedGoogle Scholar
  41. 41.
    Ti L, Ti L. Leaving the hospital against medical advice among people who use illicit drugs: a systematic review. Am J Public Health. 2015;105(12):e53–9.CrossRefGoogle Scholar
  42. 42.
    Chandrasena R, Miller WC. Discharges AMA and AWOL: a new “revolving door syndrome”. Psychiatr J Univ Ott. 1988;13(3):154–7.PubMedGoogle Scholar
  43. 43.
    Swanson JW, McCrary SV, Swartz MS, Elbogen EB, Van Dorn RA. Superseding psychiatric advance directives: ethical and legal considerations. J Am Acad Psychiatry Law. 2006;34(3):385–94.PubMedGoogle Scholar
  44. 44.
    Brock DW. A proposal for the use of advance directives in the treatment of incompetent mentally ill persons. Bioethics. 1993;7(2–3):247–56.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.University of New Mexico School of MedicineAlbuquerqueUSA
  2. 2.Alden March Bioethics InstituteAlbany Medical CollegeAlbanyUSA

Personalised recommendations