Abstract
Objective:
To de ter mine the duration of de lays in treatment initiation when involuntary patients apply for a review of a finding of treatment in capacity and to estimate the cost of keeping patients hospitalized with out treatment in these circumstances.
Method:
Using a computerized da ta base and writ ten records, we identified all patients at 2 psychiatric hospitals in Ontario who applied for a re view of a finding of treatment in capacity during a 10-yearperiod. We recorded clinical and demographic variables, dates of stopping and starting medication, and dates of review board hearings and out comes. We also noted all cases in which a patient appealed a decision from the re view board to the court.
Results:
Two hundred and thirty-seven patients made 334 applications to the re view board. The board over turned the physician's finding of incapacity in only 5 (1.5%) applications; 15 appealed the re view board's finding to the courts. None of these appeals were successful. In the absence of an appeal to the courts, the average delay in initiating treatment was 25 days. For patients appealing to the court, the average de lay was 253 days. The cost of hospitalizing un treated patients while their capacity was under legal review was estimated at $3 867 000, of which $1 333 000 could have been saved if treatment had started immediately after the review board confirmed in capacity.
Conclusion:
We have identified extensive de lays in initiating psychiatric treatment for a number of patients. These de lays are associated with le gal re view of treatment capacity. There are seriousclinical risks and substantial costs as sociated with de lay in treating patients with acute psychiatric illness. Where juris dictions review treatment capacity, we recommend that treatment not be impeded once a re view board has con firmed a clinical finding of in capacity.