Psychiatrists seek to readmit patients released by tribunals

CONSULTANT psychiatrists are seeking fresh orders to involuntarily readmit mental health patients despite requests from mental health tribunals that these patients be released.

A recent report published in the Irish Journal of Psychological Medicine found that in a survey of consultant psychiatrists, 14% responded said they had sought to have a patient readmitted to care on medical grounds after a tribunal had ruled they should be released.

That report, written by Dr Brian O’Donoghue and Dr Paul Moran, and another report by staff at the Department of Adult Psychiatry in UCD and the Mater Hospital, also found that under the Mental Health Act psychiatrists have less time to deal with patients who seek voluntary admission for treatment.

In the first paper, 70% of 236 consultant psychiatrists responded to the survey. Among the findings was that despite the recommendation by the tribunal that a patient be released, some doctors believed that the patient needed continuing care and therefore sought to have the patient readmitted.

The three-person tribunals must rule on cases of involuntary admissions, deciding on the basis of whether correct procedures were followed on the first day of the admission process — such as filling in forms correctly — and whether on the day of the tribunal, once the patient has been in care for a number of weeks, they are deemed to still require care.

If the tribunal decides to revoke the involuntary detention order but a psychiatrist disagrees with that diagnosis, he must begin the process all over again, alongside the patient’s family and GP.

Consultant psychiatrist at the Mater Hospital, Dr Brendan Kelly, said this can place the psychiatrist “in a difficult spot”, adding that “it is an area of concern to families particularly”.

“Something unfortunate could happen in that window,” he said of the period of time between a tribunal revoking an involuntary detention order and a fresh order being invoked, prompted by a psychiatrist’s clinical concerns.

Dr Kelly is the author of the second paper “A national survey of psychiatrists”, which includes responses to the implementation of the Mental Health Act 2001 in Ireland and was recently published in the Irish Journal of Medical Science.

In this report, more than 75% of consultants reported increased workloads due to the implementation of all provisions of the act, while 32% had reduced the time spent with service-users.