The aged and the dangerousness criterion in involuntary civil commitment

Using data from official court records and observations in court hearings throughout one state with a typical reform statute, this study investigates the elderly against whom petitions are brought for involuntary civil commitment. In relation to their proportion in the population, the aged are only slightly more likely than younger persons to become respondents in commitment proceedings; but they are over three times more likely to remain involuntarily hospitalized and to be subjected to recommitment proceedings. Once brought into the process, they are more likely than younger respondents to be committed and are more likely to be successively recommitted. In analyzing court testimony, focus is on evidence of dangerousness since involuntary commitment is limited to the mentally ill who are dangerous. Almost half of the young old initial respondents with formal hearings have no testimony alleging dangerous behavior and more than half of the old old have no such testimony. The alleged dangerous acts of the aged tend to be unintentional harm rather than assault.     

Does involuntary outpatient commitment lead to more intensive treatment?

Studies of involuntary outpatient commitment (OPC) among persons with severe mental illness have concluded that OPC is only effective in improving treatment outcomes when it is sustained for 6 months or longer and is combined with frequent outpatient services. This article explores factors that influence the delivery of outpatient services to subjects in a randomized trial of OPC and finds 2 general patterns. Outpatient visits were more frequent among all subjects with apparent clinical need, regardless of study assignment, and among subjects whose OPC was sustained beyond an initial court order. These results suggest that, in practice, sustained OPC represents a consensual agreement between clinicians and the court to more intensively address the complex needs of persons with severe and persistent mental illness.     

U.S. psychiatrists' beliefs and wants about involuntary civil commitment grounds

This article presents results of a national U.S. survey of psychiatrists' views about legal grounds for involuntary civil commitment. Data from 739 Respondents revealed strong support for "danger to self," "danger to others," and "grave disability" as grounds, but weak support for "illness relapse." Psychiatrists did not support commitment for addiction to drugs or alcohol nor for sexual predators. Logit regression revealed few significant associations between Respondents' choice of grounds and other variables, such as race, employment setting, experience with commitment, and political climate of the state. Respondents' support for the various commitment grounds was found to be most significantly associated with what Respondents believed the law to be in their state; Respondents tended to support the grounds they believed to be the law. The reasons for the strong association between Respondents' beliefs and wants concerning commitment grounds is explored. It is suggested that Respondents have adopted their states' commitment grounds as their preferences through a process of internalization of norms. Implications of this hypothesis are discussed.     

Effects of a new commitment law on involuntary admissions and service utilization patterns

Recently Nebraska changed its commitment law to include many procedural safeguards and require behaviorally manifested dangerousness as a criterion of commitment. An interrupted time-series design was used to determine what effects the new law had on admission characteristics and service utilization patterns of all those committed to Nebraska's three state hospitals. An immediate drop in involuntary admissions was found, but this decline was temporary. Several changes in the demographic characteristics of those committed were also found. Finally, the law apparently caused an increase in the number of those having to be readmitted. These results raise questions about the implementation of the law, the perception of dangerousness, and the need for more effective liaison between state hospitals and community-based treatment facilities.