There is hardly any research work on the evolution of a psychiatric patient's competence throughout his/her stay in hospital. This (fact) prompted our team of professionals to consider the importance of studying this evolution and trying to determine the variables affecting the improvement of that competence.

Competence to consent to hospitalization has important clinical and ethical implications. However, there are no follow-up studies that evaluate the improvement on competence during psychiatric hospitalization. The authors sought to determine whether patients admitted to a psychiatric ward as incompetent to consent to hospitalization improve their competence during hospitalization.

A total of 160 consecutively admitted patients were administered the Competence Questionnaire (CQ), a structured scale designed to assess competence to consent to psychiatric hospitalization. CQ was administered both upon admission and at discharge. Severity and acuity of the psychiatric disorder were assessed with the Severity of Psychiatric Illness Scale (SPIS) and the Acuity of Psychiatric Illness Scale (APIS).

Of the 160 assessed patients, 70 (43.8%) were rated incompetent. 45 of these 70 incompetent patients completed the admission to discharge follow-up. 21 of these 45 patients (46.6%) remained incompetent at discharge. Participation in the treatment process was the only variable which predicted improvement on competence during hospitalization. Severity of psychiatric illness at admission did not predict improvement on competence.

Nearly half of the patients admitted incompetent in an acute inpatient ward remained incompetent at discharged.