The impact of court-ordered psychiatric treatment on hospital length of stay: balancing legal and clinical concerns.

Jinah Shin, Maria Chona P San Gabriel, Agnes Ho-Periola, Sheryl Ramer, Youngihn Kwon, Heejung Bang
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Abstract

Purpose: Psychiatric hospital length of stay (LOS) is not affected solely by socio-clinical factors but also by legal procedures. This study examined the associations between legal procedures and LOS.

Methods: Data from 521 patients with psychiatric illnesses hospitalized over 2013-2015 were analyzed. Logistic regression was used to evaluate the predictors of longer (> 14 days) or prolonged (> 30) LOS with socio-clinical factors and legal procedures including court-ordered interventions (assisted outpatient treatment, medication over objection, and retention).

Results: Longer LOS occurred in 246 patients and 99 had prolonged LOS. Legal procedures affected 57 patients, with 11 assisted outpatient treatments, 39 cases of medication over objection, and 16 retentions. Longer LOS was significantly associated with six factors including older age, unmarried status, non-Hispanic race, risk of violence, schizophrenia, and legal procedures. Legal procedures had the strongest association. Longer/prolonged LOS yielded qualitatively similar associations.

Conclusion: Among 521 psychiatric inpatients, approximately 11% were mandated to receive interventions/procedures by the courts. Court-ordered legal procedures were strongly associated with longer LOS. Mental health providers may consider legal procedures for patients at high treatment/medication noncompliance risk as early as patient admission to inpatient units to prevent, intervene or prepare for a longer or prolonged LOS.

法院命令的精神病治疗对住院时间的影响:平衡法律和临床问题。
目的:精神病院的住院时间不仅受到社会临床因素的影响,还受到法律程序的影响。本研究考察了法律程序与LOS之间的关系。方法:对2013-2015年住院的521例精神疾病患者资料进行分析。使用Logistic回归来评估更长(> 14天)或延长(> 30天)LOS与社会临床因素和法律程序(包括法院命令干预(辅助门诊治疗,反对用药和保留)的预测因子。结果:246例患者出现较长时间的LOS, 99例患者出现较长时间的LOS。法律程序影响了57例患者,11例辅助门诊治疗,39例用药异议,16例保留。较长的LOS与六个因素显著相关,包括年龄较大、未婚状态、非西班牙裔种族、暴力风险、精神分裂症和法律程序。法律程序的关联性最强。较长/延长的LOS产生了质量上类似的关联。结论:在521名精神病住院患者中,约11%的人被法院强制接受干预/程序。法院命令的法律程序与较长的LOS密切相关。精神卫生提供者可在患者入院时就考虑对治疗/药物不合规风险高的患者采取法律程序,以预防、干预或为更长或延长的LOS做准备。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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