Legal Representation is Associated with Psychiatric Readmissions

The legal representation at District Psychiatric Boards hearings of psychiatric inpatients committed under a Compulsory Admission Order is a very important but insufficiently studied issue. This study aimed 1) to review the practice of legal representation in the western world and Israel, and 2) to test the hypothesis that the legal representation of compulsorily committed psychiatric patients at their discharge hearings is associated with their subsequent readmission. A random sample of 153 compulsorily committed patients discharged in 2003 was drawn from Israel s National Psychiatric Case Register and their psychiatric readmission over the next two years was reviewed. The 109 patients who were discharged with legal representation (the index group) were compared with the 44 patients who were discharged without legal representation (the control group). Although the groups were comparable on all sociodemographic and background clinical characteristics the patients from the index group had significantly more readmissions and inpatient days over the follow-up period than the control group. The results suggest that the involvement of lawyers in the discharge process is associated with more readmissions and more inpatient time. The possible reasons for this and its implications are discussed.