Admission

Given the patient's recent history of assaulting someone in the community and his escalating agitation in the emergency room, the decision is made to give the patient an emergency dose of an atypical antipsychotic medication and a benzodiazepine. When offered the medication orally with several staff present, the patient accepts it and calms gradually. When the registrar returns to interview the patient, one of the mental health nurses indicates that the patient has presented to the facility before and, though he won't give his name, is known to staff to be Mark Zuck.

The man normally lives with his mother and was recently being seen by a community mental health team.

When asked if his real name is Zuck the patient replies that he is Graviton and he is on a mission to take down the government.

The registrar considers whether to call the patient's mother and logs into the computer to see if they can access some community notes.

Voluntary versus Involuntary Admission

Generally, we classify admissions to psychiatric hospitals in one of 2 ways, voluntary or involuntary. It is worth noting that Mental Health Act legislation does not normally restrict itself to discussing involuntary admissions. It will also set rules around voluntary admissions. Patients who are admitted to hospital voluntarily also have rights. Which in NSW, include the right to ask for admission, the right to ask to be discharged, and the right to be reviewed by a Tribunal if admitted for greater than 12 months.

Another example of applying the principle of least restrictive care is altering a patient's admission status from involuntary to voluntary. Which often occurs when they have made some improvement and gained some insight.