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.
- SourceAvailable from: Marianne Larsson Lindahl
Department of Health Sciences, Lund University, 01/2011, Degree: Doctor Medical Sciences, Supervisor: Tönnesen & Öjehagen
- "Psychiatrists in Canada were presented with three hypothetical case vignettes and asked to make commitment decisions (Bagby et al. 1991). "
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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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