Enforced psychiatric hospitalization for dementia by the district psychiatrist

Dementia syndromes in the elderly are characterized by progressive deterioration and clinical and functional heterogeneity. At times a psychiatric picture prevails, and at other times, somatic as well as cognitive aspects. Accordingly, management is conducted in separate facilities, psychiatric or geriatric, which are not closely connected. The Israel Mental Health Act practically permits psychiatric commitment of every case of dementia at a certain stage of the illness. We describe a 75-year-old woman with dementia who was committed to a psychiatric hospital by order of the district psychiatrist. After attenuation of psychiatric symptoms, she remained in hospital unnecessarily. Further deterioration in physical, as well as cognitive condition, required transfer to a nonpsychiatric facility. However, due to difficulties in transfer from psychiatric to geriatric facilities, this was not accomplished. We therefor suggest broadening the authority of the district psychiatrist to include transfer of patients with dementia to appropriate, nonpsychiatric, long-term treatment facilities on termination of psychiatric treatment.