From Rebecca Weintraub Brendel and colleagues: Voluntary psychiatric hospitalization and patient-driven requests for discharge

Harv Rev Psychiatry. 2014 Jul-Aug;22(4):241-9. doi: 10.1097/HRP.0000000000000044.

Voluntary psychiatric hospitalization and patient-driven requests for discharge: a statutory review and analysis of implications for the capacity to consent to voluntary hospitalization.

Garakani A1, Shalenberg E, Burstin SC, Weintraub Brendel R, Appel JM.

Author information

• 1From the Departments of Psychiatry, Yale School of Medicine (Dr. Garakani); Icahn School of Medicine at Mount Sinai (Drs. Garakani and Appel), and Harvard Medical School (Dr. Brendel); Silver Hill Hospital, New Canaan, CT (Dr. Garakani); Visiting Nurse Service of New York, New York, NY (Dr. Shalenberg); Split Rock Rehabilitation & Health Care Center, Bronx, NY (Ms. Burstin); Center for Law, Brain, and Behavior, Massachusetts General Hospital, Boston, MA (Dr. Brendel).

Abstract

Along with the advances in civil rights protections for psychiatric patients since the 1970s, so-called voluntary inpatient psychiatric admissions have become common. In most U.S. states, however, these voluntary admissions abridge the rights of patients through legal provisions that limit the conditions under which patients can be discharged upon their request. This phenomenon, including variations in the state laws governing requests for discharge from voluntary psychiatric hospitalization, has received little attention in the psychiatry literature. Using Lexis-Nexis, PubMed, and Web of Science, we conducted a review of state laws regarding patients' legal rights to request discharge from voluntary hospitalization. Our hypothesis was that most states would have provisions limiting access to immediate discharge for patients whose psychiatric admission had been voluntary. Our findings from the review indicate that 49 of the 51 jurisdictions (50 states plus the District of Columbia) have provisions about patients requesting discharge from voluntary psychiatric admission. The majority of states employ a 72-hour period in which patients can be held following a request for discharge from hospitalization. As a general rule, after this evaluation period, either the patient must be discharged, or the facility must initiate involuntary commitment proceedings. Given these provisions, we explore the range of clinical admission procedures and whether voluntary admissions are truly voluntary. We also discuss the implications of our analysis for assessing the decisional capacity of patients seeking voluntary psychiatric admission.