Child psychiatric discharges against medical advice

Of 56 school age children admitted over a 1 year period to an urban inpatient psychiatric ward serving primarily lower socioeconomic class children, 12 were signed out against medical advice. These children were significantly more likely to have been seriously physically abused. They were more likely to have had previous psychiatric hospitalizations or residential placement. There was also a tendency for fathers to have had psychiatric treatment, be alcoholic and be drug abusers, and for the children to have higher IQs and be more violent. In addition, four particular characteristics of parents and one of children appeared clinically to be associated with these ill-advised discharges.