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PubMed2003

Two-year trends in the use of seclusion and restraint among psychiatrically hospitalized youths.

OBJECTIVES: This study examined characteristics associated with the use of seclusion and restraint among 442 psychiatrically hospitalized youths and sought to quantify changing trends in the rates of these modalities of treatment over time after the 1999 implementation of federal regulations and an institutional performance improvement program. METHODS: Demographic and clinical data related to all 5,929 incidents of seclusion and restraint that occurred during 2000 and 2001 at a child and adolescent state psychiatric hospital were analyzed. RESULTS: The two-year prevalence of use of seclusion was 61 percent and of restraint was 49 percent. Children and adolescents who were admitted on an emergency basis and those belonging to ethnic minority groups were more likely to undergo seclusion or restraint. Children aged 11 years and younger were more likely to undergo seclusion. The total number of episodes decreased by 26 percent and their cumulative duration decreased by 38 percent between the first quarter of 2000 and the last quarter of 2001. The decreases were the result of fewer seclusion and restraint incidents as well as shorter episodes of restraint. Over time, a concurrent increase was observed in the proportion of episodes associated with patient (but not staff) injuries and with as-needed use of medications. CONCLUSIONS: National reforms and institutional efforts can lead to downward trends in the use of seclusion and restraint among psychiatrically hospitalized youths. The active elements of these interventions warrant further study and replication.

Adolescent↗
PubMed1983

Emergency involuntary commitment: a look at the decision-making process.

Emergency involuntary commitment is provided in a majority of states to allow for rapid response to patients who are acutely violent and must be hospitalized quickly. The authors investigated the use of emergency hospitalization in North Carolina and found that the majority of petitions executed by law-enforcement officers did not provide adequate evidence for the required criteria. In fact, in many cases the authors noted a marked absence of such criteria. The authors discuss these results and possible reasons for the misuse of the emergency commitment provisions. They stress the importance of cooperation between community mental health professionals and law-enforcement officials in the evaluation of disruptive individuals who may be mentally disordered.

Commitment of Persons with Psychiatric Disorders↗
PubMed1988

Involuntary outpatient commitment in Arizona: a retrospective study.

In July 1983 Arizona's commitment statutes were revised to allow the courts to order involuntary outpatient treatment for the mentally ill. Using retrospective data from medical and court records, patients at a county hospital in Tucson for whom involuntary commitment was sought before outpatient commitment was available were compared with similar groups of patients after outpatient commitment was instituted. Patients ordered to receive outpatient treatment did not differ significantly in diagnosis or reason for commitment from patients committed to inpatient treatment before the change in the law. However, shorter inpatient stays were reported after outpatient commitment became available. In addition, the percentage of patients who voluntarily maintained an active relationship with community treatment centers six months after commitment increased significantly after outpatient commitment was instituted.

Adult↗
PubMed1992

Length of hospitalization and outcome of commitment and recommitment hearings.

Despite extensive legislative reformulation of civil commitment procedures, empirical studies have shown that civil commitment hearings continue to be largely nonadversarial. The authors observed all civil commitment hearings during a three-month period at a large state hospital in Virginia and examined the characteristics of patients and the actions of attorneys, clinical examiners, and judges as a function of the length of time the patient had been in the hospital. The analysis revealed that as the length of a patient's hospitalization increased, the hearings became shorter and less adversarial; patients tended to show fewer signs of acute psychiatric illness and more signs of chronic schizophrenia. The implications of these findings for civil commitment policy are discussed.

Commitment of Persons with Psychiatric Disorders↗
PubMed1995

A national survey of the use of outpatient commitment.

OBJECTIVE: To determine the extent of use of outpatient commitment, a survey was undertaken of each state and the District of Columbia. METHODS: One of the authors, an attorney, reviewed pertinent state statutes, then conducted telephone interviews with individuals in each state who were knowledgeable about the use of outpatient commitment. RESULTS: Thirty-five states and the District of Columbia have laws permitting outpatient commitment. Georgia, Hawaii, and North Carolina use different criteria for outpatient commitment than for inpatient commitment. In only 12 states and the District of Columbia was use of outpatient commitment rated as very common or common. Reasons for not using it include concerns about civil liberties, liability, and fiscal burden as well as lack of information and interest, the failure of some states to set enforceable consequences for noncompliance, and criteria that are too restrictive. Some states use alternative formal or informal mechanisms to encourage treatment compliance; conditional release is widely used in New Hampshire and conservatorship-guardianship in California. Within many states the availability of outpatient commitment varies considerably by locale. CONCLUSIONS: To clarify the role of outpatient commitment in psychiatric services, more research is needed to identify optimal candidates for its use. Research is also needed on its overall effectiveness compared with conditional release and conservatorship-guardianship and on the consequences of not using such mechanisms to improve treatment compliance.

Ambulatory Care↗
PubMed1999

Application of the powers of compulsory admission to psychiatric hospital by general practitioners, social workers and psychiatrists.

Ways of extending or consolidating the powers of compulsory admission under the Mental Health Act 1983 have been discussed by the government and other organizations, including the Royal College of Psychiatrists. However there is little data on how existing legislation is applied. The authors examined the differential application of the Act between GPs, psychiatrists and social workers by means of an anonymous, confidential questionnaire. Fourteen case vignettes were interpreted by 20 social workers, 19 GPs and 28 Section 12 approved psychiatrists, who were asked to decide if they would detain the patient under the Act. Responses were analysed between and within the three groups. There was general agreement between groups on situations involving 'danger to self' and 'danger to others', but social workers were less likely to detain on health grounds and GPs tended to use the Act unpredictably, in areas not covered by the Act. The authors conclude that the Act may not be used to its fullest extent due to differences in interpretation or in knowledge, which may arise from differential constructs of mental illness and training. A national study of knowledge of mental health law is suggested.

Adult↗
PubMed1998

Mental health legislation and the right to appropriate treatment.

OBJECTIVE: To demonstrate how mental health legislation and its implementation can detract from a patient's "right to health." METHOD: The author surveyed colleagues working at the London and St Thomas Psychiatric Hospitals about cases where the structure or implementation of the Mental Health Act in Ontario impeded the provision of good psychiatric care. RESULTS: Four clinical vignettes illustrate specific problems; possible solutions to these difficulties are suggested. CONCLUSION: Physicians must remain vigilant in their role as advocates for patients' right to appropriate treatment.

Adult↗
PubMed2001

Deprivation of liberty in psychiatric treatment: a Finnish perspective.

This article is concerned with the deprivation of patients' liberty while undergoing psychiatric treatment, with special reference to the situation in Finland. It is based on a review of Finnish law, health care statistics, and empirical and theoretical studies. Relevant research findings from other countries are also discussed. In Finland, it is required that patients are cared for by mutual understanding with themselves; coercive measures may be applied only if they are necessary for the treatment of the illness, or for safeguarding patients' safety or the safety of others. Involuntary psychiatric hospitalization is closely regulated by the Mental Health Act. However, the rules concerning the deprivation of liberty during inpatient treatment (by seclusion, restraint and restricted leave) are formulated in very general terms. Therefore, Finnish psychiatric hospitals have their own policies concerning when and how seclusion may be used. The practice of seclusion and the use of restraint therefore vary among the psychiatric hospitals in Finland.

Commitment of Persons with Psychiatric Disorders↗