An Investigation into the After-History of 90 Patients Discharged from a Mental Hospital Against Advice

Abstract

In this paper an attempt has been made to ascertain the after-histories of a particular group of patients discharged from the Maudsley Hospital, namely, those for whom further institutional treatment was considered necessary, but in whose case this advice was not taken. The investigation covers a period of three years, from 1928 to 1931. At the outset it must be pointed out that the Maudsley Hospital deals exclusively with voluntary patients, who are free to leave on giving twenty-four hours' notice; in addition, no patient is certified in the hospital, but where this is considered necessary, the friends are advised as to the procedure to be followed. In the circumstances, it might be thought that the number of patients who were taken home against advice would be high; but this was not the case. In a number of cases further institutional treatment was deemed necessary on grounds of psychotherapy alone; and if these are excluded, only 90 patients remain who were considered unfit for any but institutional care, either because they were dangerous to themselves, or because they were likely to prove dangerous or at least a nuisance to others. During the period under review 3, 248 patients were admitted to hospital and 2, 282 were discharged, so that the cases dealt with in this paper constituted only 2–8% of admissions and 3.5% of discharges. Of the 90 patients, 50 were females and 40 males. The length of stay in hospital varied from one day to one year.