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PubMed1983

Are lawyers enemies of psychiatrists? A survey of civil commitment counsel and judges.

The author surveyed 101 attorneys and judges involved in civil commitment procedures to answer the question of how they view psychiatrists, mental hospitals, and the mentally ill. She found that these lawyers and judges tended to view psychiatrists in favorable terms, that their attitudes toward mental hospitals reflected their perception of the weaknesses of these hospitals and their view of hospitalization as a last resort, and that they tended to reject negative statements about the mentally ill. She discusses the effect of these attitudes on the behavior of lawyers and judges toward psychiatrists and the mentally ill in civil commitment hearings.

Attitude↗
PubMed1987

Competency determinations in civil commitment.

The authors present a brief overview of competency determinations in criminal justice and civil commitment proceedings and review the American Psychiatric Association's Model Commitment Statute, which gives competency a central role. They present an alternative proposal that involves determining a person's competency to undergo civil commitment before a formal commitment hearing and delineates the responsibilities of legal and medical decision makers in the commitment process.

Commitment of Persons with Psychiatric Disorders↗
PubMed1989

Civil commitment standards and patient mix in England/Wales, Italy, and the United States.

Although England/Wales, Italy, and the United States share a common policy of deinstitutionalization, their mental health systems differ considerably. Each country's civil commitment standards define patient eligibility criteria along one of two primary dimensions--need for treatment or degree of dangerousness. These differential selection criteria result in mental health systems serving different subgroups of the total population. The criteria in England/Wales target older women; in the United States, younger men; and in Italy, a group balanced in age and sex. Implications for the current debate on civil commitment policies are considered.

Adolescent↗
PubMed1984

Police involvement and influence in involuntary civil commitment.

Although observers agree that the police play an important role in involuntary civil commitment of mentally ill individuals, there are scant empirical data to document the importance of the police in swaying the commitment decision. The authors studied 3,570 randomly selected case records of individuals referred to two county offices of civil commitment in Washington State to determine the types of referrals police become involved in , the extent to which referral sources request police assistance, and the percentage of referrals resulting in commitment with and without police involvement. The authors conclude that police most often are asked to assist in cases involving violent behavior, but that under almost all circumstances police involvement is the primary factor in determining whether referral will result in commitment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1996

The effectiveness of outpatient civil commitment.

The effects of outpatient civil commitment on community tenure and functioning were studied in a group of 20 patients with a history of recurrent hospitalizations, noncompliance with outpatient treatment, and good response to treatment. During the first 12 months of outpatient commitment, patients experienced significant reductions in visits to the psychiatric emergency service, hospital admissions, and lengths of stay compared with the 12 months before commitment. They significantly increased the number of appointments kept with their psychiatrist. It appears that when used judiciously, outpatient civil commitment is a helpful tool in maintaining hospital recidivists in the community.

Adult↗
PubMed2004

Sexual predator civil commitment: a comparison of selected and released offenders.

This study compared two groups of sex offenders who were considered for civil commitment under Florida's Jimmy Ryce Act: Two hundred twenty-nine sex offenders who were recommended by forensic evaluators to be civilly committed and 221 sex offenders who were recommended for release. It was hypothesized that selected offenders would be more likely to display risk factors for sex offense recidivism than those who did not meet criteria. Data analyses revealed that selected offenders, as a group, scored significantly higher on actuarial risk assessment instruments. There were also significant differences between the groups on other risk factors that have been empirically correlated with sexual recidivism. Selected offenders had higher frequencies of paraphilia diagnoses and antisocial personality. These findings supported the hypotheses and suggested that evaluators are correctly selecting for civil commitment those sex offenders who have a mental abnormality predisposing them to sexual violence and who are at higher risk for reoffense.

Adult↗
PubMed1985

Civil commitment trends in Ontario: the effect of legislation on clinical practice.

The rationale for and history of civil commitment legislation in Ontario are reviewed. The civil commitment rate in Ontario from 1926 to 1980 for provincial psychiatric hospitals, and from 1974 to 1980 for all psychiatric inpatient facilities was analyzed to detect variation in the rate over time and with relevant legislation. The findings indicate that mental health legislation has had little effect on commitment practices in Ontario. In addition, the variation in the commitment rate over the period reviewed cannot be ascribed to inconsistent application by physicians. The other variables affecting the rate are discussed in this context. The need for more descriptive studies of the major determinants of the commitment rate is emphasized.

Commitment of Persons with Psychiatric Disorders↗
PubMed1986

Psychiatry, civil liberty, and involuntary treatment.

Growing concern for involuntary patients' civil rights has engendered criticism of psychiatry. Critics have disputed the reality of mental illness and have alleged that psychotic disturbances result from diagnostic "labels". Media accounts continue to depict the psychotically ill as abused victims rather than as patients requiring treatment. In the face of such attacks, psychiatrists need public support from their medical colleagues as well as from members of the lay public. The historical and socioeconomic factors germane to psychiatry are reviewed in an attempt to understand the current dispute about involuntary treatment. It is argued that the concept of civil liberty requires consideration of psychological freedom. Since psychotic patients are without psychological freedom, it is meaningless to respect their apparent liberty at the expense of allowing them to go untreated. Those who refuse treatment for what are deemed to be irrational reasons should receive treatment involuntarily. If society cannot trust psychiatrists to make such treatment decisions, the courts should make them.

Attitude to Health↗
PubMed1987

Civil commitment and consent for electroconvulsive therapy in Ontario.

Among the most contentious legal and ethical issues concerning the use of electroconvulsive therapy (ECT) are the criteria for obtaining a valid consent to treatment and its administration to involuntarily hospitalized patients, with or without consent. This paper reviews the consent process, in particular the assessment of competence, as it is affected by the symptoms and clinical circumstances, including civil status, of those patients for whom ECT is prescribed. The ECT caseload at one psychiatric facility was reviewed to determine the diagnosis and civil status of each patient and the source of consent for each course of ECT prescribed over a 10-year period. Significant differences were found in the diagnostic distribution and the source of consent by diagnostic group between the 1,042 courses administered to informal patients and the 249 courses to involuntary patients. The results are discussed in the context of relevant Ontario legislation and hospital policies. Recommendations are made for the improvement of procedural safeguards to protect the autonomy of all patients.

Commitment of Persons with Psychiatric Disorders↗
PubMed2006

Incremental validity analyses of the violence risk appraisal guide and the psychopathy checklist: screening version in a civil psychiatric sample.

This study compares two instruments frequently used to assess risk for violence, the Violence Risk Appraisal Guide (VRAG) and the Psychopathy Checklist: Screening Version (PCL:SV), in a large sample of civil psychiatric patients. Despite a strong bivariate relationship with community violence, the VRAG could not improve on the predictive validity of the PCL:SV alone, even though the VRAG includes several ostensible violence risk factors other than psychopathy. Moreover, incremental validity analyses indicated that the remaining VRAG items accounted for little or no variance in violent outcomes once psychopathy scores were controlled. Conversely, the PCL:SV continued to account for considerable variance after controlling for the VRAG. These results reflect the limited validity of the VRAG items in civil psychiatric samples beyond the variance that is explained by the PCL:SV alone.

Antisocial Personality Disorder↗
PubMed2003

The use of actuarials at civil commitment hearings to predict the likelihood of future sexual violence.

Some have argued that acturarial methods such as the RRASOR, the MNSOSTR, and the Static-99, can outperform clinical judgments when utilized at a civil commitment hearing to make a prediction. Although actuarial data can be used to identify a group of persons to be considered for possible civil commitment, at present it cannot be used to accurately predict the likelihood of future acts of sexual violence with respect to any specific individual within such a group. For that reason, it might be best to restrict the use of acturial data to the initial screening process, rather than introducing it at the commitment hearing itself.

Actuarial Analysis↗
PubMedDate not supplied

Civil and war peripheral arterial trauma: review of risk factors associated with limb loss.

We sought to analyze the early results of civil and war peripheral arterial injury treatment and to identify risk factors associated with limb loss. Between 1992 and 2001, data collected retrospectively and prospectively on 413 patients with 448 peripheral arterial injuries were analyzed. Of these, there were 140 patients with war injuries and 273 patients with civil injuries. The mechanism of injury was gunshot in 40%, blunt injury in 24%, explosive trauma in 20.3%, and stabbing in 15.7% of the cases. The most frequently injured vessels were the femoral arteries (37.3%), followed by the popliteal (27.8%), axillary and brachial (23.5%), and crural arteries (6.5%). Associated injuries, which included bone, nerve, and remote injuries affecting the head, chest, or abdomen, were present in 60.8% of the cases. Surgery was carried out on all patients, with a limb salvage rate of 89.1% and a survival rate of 97.3%. In spite of a rising trend in peripheral arterial injuries, our total and delayed amputation rates remained stable. On statistical analysis, significant risk factors for amputation were found to be failed revascularization, associated injuries, secondary operation, explosive injury, war injury (p < .01) and arterial contusion with consecutive thrombosis, popliteal artery injury, and late surgery (p < .05). Peripheral arterial injuries, if inadequately treated, carry a high amputation rate. Explosive injuries are the most likely to lead to amputations, whereas stab injuries are the least likely to do so. The most significant independent risk factor for limb loss was failed revascularization.

Adult↗
PubMed2000

Civil commitment of sex offenders to mental institutions: should the standard be based on serious mental illness or mental disorder?

Civil commitment to mental institutions requires that an individual be both seriously mentally ill and dangerous. This principle is erroneously being applied to incarcerated sex offenders nearing release from prison under the theory that they have antisocial personalities or paraphilia disorders, which are called mental illnesses. However, the mental health and legal communities are at odds regarding the use of a diagnosis of personality disorder or paraphilia to justify civil commitment. The author reviews the differences between serious mental illness and mental disorder, the flaws with assessing sex offenders as mentally ill, and the ethical dilemma for social workers employed in mental hospitals.

Commitment of Persons with Psychiatric Disorders↗
PubMed2003

Policy interventions designed to combat sexual violence: community notification and civil commitment.

Much attention has been given to the problem of sexual predators and the struggles of the legal-justice system to contain them. In response to public outcry over high-profile sex crimes, federal and state legislators have responded in the past decade with innovative but controversial public policy initiatives, called "sexually violent predator statutes." In 1996 President Clinton signed "Megan's Law," mandating all 50 states to develop requirements for convicted sex offenders to register with local law enforcement agencies and to notify communities when a sex offender lives in close proximity. Less publicized have been the civil commitment statutes introduced by 16 states which allow convicted sex offenders to be evaluated for involuntary and indefinite confinement in a psychiatric hospital following their release from prison. This article will review the literature regarding community notification and civil commitment as interventions designed to combat sexual violence. The history and context of each policy will be discussed, as will a review of available research evaluating the impact of each policy. Implications for future research and social policy will be examined.

Adult↗
PubMed2002

Testosterone, alcohol, and civil and rough conflict resolution strategies in lesbian couples.

The present study investigated the relations among testosterone level, acute alcohol consumption, and the use of violent (Rough) or non-violent (Civil) conflict resolution strategies in lesbian couples. The participants were 54 lesbian campers at a women's campground or spectators at a gay pride celebration who each provided a saliva sample for testosterone assay and completed a questionnaire. On the questionnaire, participants indicated whether they used Civil or Rough tactics to deal with domestic discord, and whether or not their use of these tactics varied with their use of alcohol. High testosterone women used Rough tactics equally when drinking as when not drinking, while low testosterone women used Rough tactics far more often when drinking than when not drinking. Alcohol appears to release violent tenden- cies in low testosterone women, who are characteristically restrained under sober conditions, but has little effect on high testosterone women.

Adult↗
PubMed2005

In search of a more perfect heteroarchy:Vermont, civil unions and the harm of "separate-but-equal".

This article focuses on the Vermont civil union solution to the state Supreme Court's mandate in Baker v. State (1999). Using non-subordination theory, the author argues that rather than being a legal victory for lesbians and gay men, the Vermont law integrally contributes to the maintenance of an imbalance of power between heterosexuals and lesbians and gays. The article analyzes the rhetorical strategy employed by lawmakers to respond to what they perceived and portrayed as a menace posed by same-sex marriage and demonstrates that lawmakers reinforced apprehensions surrounding lesbian and gay identity and asserted the familiar heterosexist narrative in an effort to quell the threat posed by Baker. The article concludes that the legislature's genuine motivation behind civil unions was validating their own and their constituents' misplaced fears regarding gay and lesbian identity, and pacifying those fears by denying equal marriage rights to gays and lesbians in an attempt to appear responsive to a perceived threat to heterosexual primacy.

Female↗
PubMed2006

Mental disabilities in Western civilization from Ancient Rome to the Prerogativa Regis.

A preliminary survey of formal concepts of disability from the Twelve Tables of Rome of the 5th century BCE to the Prerogativa Regis in English law of the late 13th century CE is presented. Firm conclusions are restricted by problems in translation and other limitations in available data. However, it appears that the concept of intellectual disability and its distinction from episodic mental illness first emerged in several subcultures of Western civilization during the height of ancient imperial Rome and during the early medieval period in Northern European and Arabic civilization.

England↗
PubMed2005

The evolution of euthanasia and its perceptions in Greek culture and civilization.

Death has preoccupied humanity since before the dawn of civilization. As a multidimensional and moral problem, the end of life has concerned different civilizations, and different approaches to euthanasia, or "good death," have been developed in each culture. In Greece, there is a long record of the culture's evolving attitudes toward death and euthanasia.A more widespread knowledge of the views and traditions surrounding the act of euthanasia can contribute to a better understanding of the controversies surrounding modern attitudes and practice.

Anthropology, Cultural↗