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Do dangerousness-oriented commitment laws restrict hospitalization of patients who need treatment? A test.

A study at a large urban psychiatric hospital in Pennsylvania evaluated whether the state's dangerousness-oriented commitment criteria restricted hospitalization of patients whom emergency room clinicians considered highly in need of treatment but not dangerous. A total of 390 patients were studied. Eleven patients judged to be highly in need of treatment did not meet any of the commitment criteria, but they were largely compliant with the idea of being treated. An additional 17 patients considered highly in need of treatment met criteria for commitment based on inability to care for self, but most were hospitalized voluntarily. Only one patient who met none of the commitment criteria resisted recommended hospital care, and she was eventually committed involuntarily based on inability to care for self. The data suggest that dangerousness-oriented commitment criteria are flexible enough to provide for treatment of patients in serious need.

Activities of Daily Living↗

Community powers under the Mental Health Act: care or control?

District Nursing Sister Janet Jones had been visiting a young patient, Peter James, 20, at his bedsit on a weekly basis to assist him with the management of his diabetes. However some 6 months ago Peter stopped eating and began refusing to take his insulin because he believed that they had been contaminated by alien dust. Sister Jones and the GP also noticed that Peter was drinking considerable quantities of alcohol and there were reports of him engaging in bizarre sexual rituals. Concern about Peter's mental health and refusal of treatment resulted in him being detained under the Mental Health Act 1983. Sister Jones has now received a request from the mental health unit to visit Peter at his home during a period of leave he has been granted by his responsible medical officer (RMO) and to continue visiting as part of his aftercare arrangements when he is discharged. Sister Jones wonders if the mental health team will be able to manage Peter in the community given his previous reluctance to accept treatment and how Peter will afford the aftercare package of home care support and meals on wheels provided by the local authority.

Aftercare↗

Coercive measures in psychiatric care. Reports and reactions of patients and other people involved.

In ongoing studies of the quality of the mental health services in two Swedish counties, two thirds of the committed versus about one third of the voluntarily admitted patients reported coercive measures during the index period of care. Committed patients reported an equal degree of coercive treatment and restraint, whereas restraint dominated among the voluntarily admitted. The majority of the patients described the coercive measures as implemented by fait accompli; force was reported in 23% of the examples given by the committed patients but never by the voluntarily admitted. The committed patients justified 19% and the voluntarily admitted 38% of the coercive measures reported; the committed patients justified coercive treatment and restraint to about the same extent; the voluntarily admitted patients justified 65% of the examples of restraint but only 20% of the examples of coercive treatment. There was a 70% concordance between the reports of the committed patients and psychiatric personnel as to the occurrence of coercion, but the head nurses tended to state that treatment had been implemented by persuasion in cases where the patients stated that implementation was by coercion.

Adolescent↗

Ulysses contracts.

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Advance Directive Adherence↗