Decision making in psychiatric civil commitment: an experimental analysis.
ABSTRACT Legislation in Canada and the United States that was intended to decrease the use of civil commitment has resulted in a paradoxical increase in involuntary hospital admissions. To elucidate the reasons for this increase, this study was designed to assess the relative importance of various factors involved in the decision to commit a patient.
All psychiatrists in Ontario were sent a questionnaire asking them to make commitment decisions based on hypothetical case vignettes. Four factors were systematically varied in the vignettes: the patients' legal commitability, clinical treatability, alternative resources, and psychotic symptoms. Completed questionnaires, with three vignettes each, were returned by 495 respondents.
All four variables were statistically significant in the expected direction; legal commitability (i.e., dangerousness to self and/or others, inability to care for self) and presence of psychotic symptoms accounted for the majority of the variance in the final decision to commit.
These results suggest that psychiatrists in Ontario rely primarily on legally mandated factors (i.e., psychosis and dangerousness) in making their decisions to commit, although a considerable amount of individual variation is also evident.
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ABSTRACT: Objective: To canvass the opinions of psychiatrists working in forensic settings on the definition of forensic patient and treatablity. Method: A questionnaire was circulated. Respondents were asked to define forensic patient, associated social dangerousness with mental health and involvement with judicial system. Results: Forty-eight (44%) of the 109 respondents attempted to define forensic patient. Only 54% considered forensic patient in general as treatable. Conclusions: Most of the psychiatrists failed to agree on a mutual definition and tended to include forensic issues when attempting to define the forensic patient. Furthermore a significant minority believe that forensic patients can benefit from treatment. This has important implications, both for the general education of psychiatrist and for forensic psychiatry. (Rawal Med J 2004;29:68-70)
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ABSTRACT: To elucidate disparities in clinical and legal documentation for patients admitted involuntarily to a county psychiatric hospital in Texas. The study sample comprised of 89 randomly selected patients, involuntarily hospitalized to our facility in September 2011. All patients met criteria for involuntary detention based on the legal documents filed by admitting psychiatrists. Electronic medical records were reviewed to assess if the clinical documentation from the same date when legal documents were filed; demonstrated criteria for involuntary detention (harm to self, harm to others, inability to care for self). A logistic regression model was used to assess the predictors of concordance between legal and clinical documentation of involuntary detention criteria. Of 89, 6 patients were made voluntary, while two were discharged within 24 h, thus removed from the analysis pool. Of 81, 31(38.2 %) patients lacked sufficient clinical documentation on medical records required for involuntary hospitalization. Patients, for whom detention was justified in clinical notes, were more likely to have single marital status, longer duration of hospitalization and they were more likely to undergo commitment for further inpatient mental health treatment. Our study found that involuntary detention of many patients based on the legal documents filed by admitting psychiatrists was not justified by the clinical documentation. This indicates that appropriate standards are not maintained when completing the medical certificates for involuntary detention. Maintaining appropriate standards may reduce the need for involuntary hospitalization, increase patient autonomy, and reduce resource utilization.Psychiatric Quarterly 02/2014; 85(3). DOI:10.1007/s11126-014-9289-3 · 1.26 Impact Factor
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ABSTRACT: Swedish physicians (five specialists and five assistant physicians) in acute psychiatric care narrated their experiences with using coercion. The commonest action using coercion related to in all the interviews was forced injection. The assistant physicians also described persuasion as an action using coercion. A content analysis showed four characteristic themes from the physicians' narratives: being in conflict with the patient, being under pressure and avoiding conflict, being in conflict with ethical demands, and needing reflection and support. The physicians expressed being in conflict with the patient and being under pressure and avoiding conflict with nursing staff, colleagues, and legal demands. For most of these physicians this resulted in a conflict with the ethical demands of giving good care. Ways to relieve pressure and conflict when using coercion with psychiatric patients included connecting with the patient, agreeing and reflecting with nursing staff and colleagues, and gaining more support from colleagues.Nordic Journal of Psychiatry 07/2009; 53(3):203-210. DOI:10.1080/080394899427214 · 1.50 Impact Factor