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Patients Threatening Harm to Others Evaluated in the Emergency Department under the Florida Involuntary Hold Act (Baker Act)
- Source :
- South Med J
- Publication Year :
- 2019
- Publisher :
- Southern Medical Association, 2019.
-
Abstract
- Objectives This study describes the specific threats of harm to others that led to the use of the Baker Act, the Florida involuntary hold act for emergency department (ED) evaluations. The study also summarizes patient demographics, concomitant psychiatric diagnoses, and emergent medical problems. Methods This is a retrospective review of 251 patients evaluated while on involuntary hold from January 1, 2014 through November 30, 2015 at a suburban acute care hospital ED. The data that were collected included demographic information, length of stay, reason for the involuntary hold, psychiatric disorder, substance use, medical illness, and violence in the ED. The context of the homicidal threat also was collected. Results We found that 13 patients (5.2%) were homicidal. Three patients had homicidal ideations alone, whereas 10 made homicidal threats toward others. Of the 10 making homicidal threats, 7 named a specific person to harm. Ten of the 13 homicidal patients (76.9%) also were suicidal. Eleven patients (84.6%) had a psychiatric disorder: 9 patients (69.2%) had a depressive disorder and 8 patients (61.5%) had a substance use disorder. Eight patients had active medical problems that required intervention in the ED. Conclusions We found that three-fourths of patients expressing homicidal threats also were suicidal. The majority of patients making threats of harm had a specific plan of action to carry out the threat. It is important to screen any patient making homicidal threats for suicidal ideation. If present, there is a need to implement immediate management appropriate to the level of the suicidal threat, for the safety of the patient. Eighty-five percent of patients making a homicidal threat had a previously documented psychiatric disorder, the most common being a depressive disorder. This finding differs from previous studies in which psychosis predominated. More than 60% of homicidal patients had an unrelated medical disorder requiring intervention. It is important not to overlook these medical disorders while focusing on the psychiatric needs of the patient; most of our homicidal patients proved to be cooperative in the ED setting.
- Subjects :
- Adult
Male
medicine.medical_specialty
Adolescent
Poison control
Suicide, Attempted
Context (language use)
Violence
01 natural sciences
Suicide prevention
Article
Young Adult
03 medical and health sciences
0302 clinical medicine
Risk Factors
Acute care
Intervention (counseling)
medicine
Humans
030212 general & internal medicine
0101 mathematics
Psychiatry
Suicidal ideation
Aged
Retrospective Studies
Aged, 80 and over
business.industry
010102 general mathematics
General Medicine
Emergency department
Middle Aged
medicine.disease
Substance abuse
Florida
Commitment of Mentally Ill
Female
medicine.symptom
Emergency Service, Hospital
business
Subjects
Details
- ISSN :
- 15418243 and 00384348
- Volume :
- 112
- Database :
- OpenAIRE
- Journal :
- Southern Medical Journal
- Accession number :
- edsair.doi.dedup.....89b40cedf2b4c98fa1b00482f37ba02b