Discharge of adolescents with mental health problems against medical advice: Findings from adult mental health inpatient facilities across Ontario, Canada

Little is known about discharge against medical advice (DAMA) among adolescents with mental health problems. The objective of this study was to examine the prevalence of DAMA and provide some insight into the factors that influence DAMA among adolescents with mental health problems using a large dataset from Ontario, Canada. Data on 1811 adolescents aged 14-18 years who were discharged from adult mental health beds between October 2005 and March 2010 were analyzed using logistic regression. Of the 1811 discharges in the sample, 78(4.3%) were against medical advice. In the multivariate model, older age, having limited insight or no insight into mental illness, provisional DSM-IV diagnoses of substance-related disorders, eating disorders, and personality disorders increased the odds of DAMA. Length of stay was negatively associated with DAMA. The findings of this study highlight the importance of completing comprehensive assessments at the time of admission to identify adolescents who are at risk of treatment refusal and provide timely intervention to prevent DAMA.