Involuntary psychiatric hold

Background

  • Involuntary hospitalization of patient threatening/attempting to leave the ED for purposes of evaluating patient's risk of harm to self/others and/or ability to safely care for self.
  • Exact criteria and process vary by jurisdiction

Evaluation

"Clinical factors related to admission and release decisions in psychiatric emergency services" [1][2]

  • in declining order of importance:
  1. level of danger to self
  2. severity of psychosis
  3. ability for self care
  4. impulse control
  5. severity of depression ( SIGECAPS , SAD PERSONS )


Crisis Triage Rating Scale [3]

  • 3 is worst, 15 is best
  • has not been validated for ED use[4]
Element Components
Dangerousness (from most severe to least severe) 1. Acute SI/HI, current serious SI/HI attempt, unpredictable
2. History of violent/impulsive behavior but no current signs
3. AmbivalentSI/HI but ineffective gestures
4. SI/HI but desire to control behavior
5. No SI/HI and no history of violent/impulsive behavior
Support System (from worst to best) 1. None
2. Some but limited effectiveness
3. Some but not easy to mobilize
4. Yes but limited
5. Yes and good support
Cooperation (from worst to best) 1. Not able or refuses
2. Little interest in cooperating
3. Passive acceptance of help
4. Wants help but desire limited
5. Strong desire for help and will cooperate

See Also

External Links

References

  1. Way BB, Banks S: Clinical factors related to admission and release decisions in psychiatric emergency services. Psychiatr Serv 52: 214, 2001.
  2. Tintinalli's Emergency Medicine A Comprehensive Study Guide, 9th edition Tintinalli, Ma, Yealy, Meckler, Stapczynski, Cline, and Thomas
  3. Bengelsdorf H, Levy L, Emerson R, et al: A crisis triage rating scale: brief dispositional assessment of patients at risk for hospitalization. J Nerve Mental Dis 172: 424, 1984.
  4. Tintinalli's Emergency Medicine A Comprehensive Study Guide, 9th edition Tintinalli, Ma, Yealy, Meckler, Stapczynski, Cline, and Thomas