Discharge of psychiatric patients against psychiatrist’s advice

Abstract

Using the standard checklist to determine the reasons for discharge of psychiatric patients against psychiatrist's advice cannot correctly determine the main reasons for discharge due to the exceptional circumstances of patients when they wish to leave the hospital. →What this article adds:Completing the standard checklist based on face-to-face interviews with patients who wish to be discharged from the psychiatric ward against their psychiatrist's advice helps to determine the main reasons for discharge more correctly. The resulting information can also help by providing the chance to change the patient's decision for discharge against medical advice.

Exploring the inner roots of discharge against medical advice (DAMA) in an academic psychiatric hospital: a qualitative study

“…Secondly, it is possible that the information of patients' families/ relatives about the psychiatric disorder and the process of healing is inadequate or they may even deny the problems substantially, and as some of the symptoms have been relieved, they rush to discharge their patient. This concept was replicated in other research [3,5].…”

“…They classified the reasons stated by the patients and caretakers into three main factors: (1) patient-related, (2) hospital environment-related, and (3) health care providers related. Some of their findings have been almost replicated in our study including “inadequate nursing care,” “dissatisfaction with medical care,” and “improper communication.” However, according to methodological differences, deep feelings like missing the beloved one, worries, and concerns were not explored [ 5 ].…”

“…It is difficult to have in-depth interviews with psychiatric patients or their families/relatives who leave the hospital because there is often some dissatisfaction that reduces their cooperation. This probably describes why most existing studies on the subject of DAMA in psychiatric wards have used checklists or closed questions [ 3 – 5 , 20 , 21 ]. Despite the limitations of qualitative research, asking open-ended questions and addressing the feelings of patients and their families/relatives often gives insights that are not available in other methods.…”

“…The possible associated factor of DAMA has been mentioned in previous research, which includes hospital service dissatisfaction, financial problems, family problems, caregiver-patient communication, belief in traditional medicine, discomfort with an extended stay in the hospital, and feeling of recovery [ 5 , 6 ]. According to the fact, the environmental factors play a major role in DAMA, and the generalization of the associated factor in one center should be done with caution [ 7 ].…”

“…Under Iranian law, the care and guardianship of patients with severe mental illness (SMI) including schizophrenia, bipolar disorder, and schizoaffective disorders are assigned to their relatives/families that are usually one of their families/relatives. Since most patients admitted to psychiatric hospitals are SMI, as a general regulation, the responsibility for DAMA for all patients admitted to psychiatric hospitals in Iran is assigned to patients’ families/relatives, not to themselves [ 5 ]. Therefore, it is logical that in a study that intended to explore the inner roots of DAMA, most of the focus will be on the families/relatives of the patients who are the major agent in DAMA according to rules and regulations.…”