Police Referrals to a Psychiatric Hospital: Indicators for Referral and Psychiatric Outcome

Studies of police psychiatric referrals in the USA and the UK generally show these patients to be ill and in need of care. There are, however, no published Australian studies and such findings may not be validly generalised. This prospective study of consecutive police psychiatric referrals in Adelaide reports psychiatric assessment in 92 cases and observations by police in 69 of these, with no evidence of selection bias. The most common reason for referral was threat of self harm (28%). Mental illness was deemed to be present in 49% and the most common clinical description was "situational crisis" (29%). Schizophrenia was diagnosed in 18%. Clinicians viewed 19% of referrals as inappropriate. Increased relative odds for mental illness were associated with police accounts of psychotic symptoms, and decreased odds with threat of self harm and violence. Increased odds for admission were associated with language difficulties and damage to own property, decreased odds with threat to others, threat of suicide, and threat to self injury. There were 14 cases where possible charges were not being pursued: of these 7 were regarded as ill and 4 were regarded as inappropriate referrals. The rates of major disorders are lower than in other published work. It is proposed that this can be explained by relative ease of referral by police to psychiatry and flexible acceptance criteria.