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PubMed2001

Involuntary treatment of alcohol-dependent patients: a study of 17 consecutive cases of civil commitment.

AIM: To investigate the baseline and follow-up characteristics of a group of alcohol-dependent patients being treated under civil commitment. METHODS: This study involved a cross-sectional comparative analysis of baseline characteristics and a follow-up survey of a group of committed alcoholic patients. The study was undertaken in the Alcohol Unit of a 1,000-bed general and university hospital. The study included 17 consecutive cases of civil commitment (representing 15 patients, of whom 2 were committed twice) and a comparative group of 34 randomly selected age- and sex-matched patients. Baseline characteristics of the cases (at the time of commitment) and of patients from the comparative group were collected from medical records, including sociodemographic data, medical condition, patterns of drinking and number and dates of previous treatments for alcohol-related problems. A structured follow-up interview of the cases provided information on their medical condition, social status, patterns of alcohol use, type and duration of residential treatment as well as their perceptions of commitment. RESULTS: During a 4-year period, our Unit referred 23 cases of alcohol-dependent patients (out of 367) to the Guardianship Authority, requesting civil commitment. On 17 occasions, patients were committed to residential treatment, including 2 patients who underwent commitment on two separate occasions, thus representing a total of 15 different patients. In comparison with age- and sex-matched patients seen at the Unit, the cases were characterized by multiple medical, social and psychological alcohol-related impairments. At the time of follow-up, 14 out of 15 patients were alive, among whom 10 agreed to be interviewed. Eight of these reported complete abstinence, whereas 9 considered their alcohol problem as less severe than before. The average duration of commitment was 29 weeks. The majority of patients retrospectively considered the measure as having been justified and useful. The patients' satisfaction with the decision to commit was higher among women than among men. Health-related quality of life at the time of follow-up, as assessed by the MOS 36-Item Short Form Health Survey questionnaire, was good on average and better than that usually reported by other cohorts of alcoholics undergoing treatment. CONCLUSIONS: The usefulness of residential civil commitment of certain severely impaired alcohol-dependent patients is underscored. This study suggests that civil commitment not only may save the lives of endangered patients but could also be a health-promoting measure that may sometimes allow for recovery from dependence. Unexpectedly, this measure was retrospectively well accepted by many patients, who considered the commitment decision as having been justified and useful.

Alcoholism↗
PubMed2006

Use of outpatient commitment or related civil court treatment orders in five U.S. communities.

OBJECTIVE: Outpatient commitment and a number of related civil court mechanisms are used to attempt to improve adherence to mental health treatment in the community. This study examined lifetime use rates and correlates of outpatient commitment or related civil court-ordered outpatient treatment in five U.S. communities. METHODS: A total of 1,011 outpatients were recruited and interviewed from five sites: Chicago; Durham, North Carolina; San Francisco; Tampa; and Worcester, Massachusetts. RESULTS: Between 12 and 20 percent of consumers reported outpatient commitment or related civil court-ordered treatment. A history of outpatient commitment or related court orders was significantly more common among participants who lived in staffed residential settings, received assistance with outpatient treatment, and reported poor social support as well as among those who had co-occurring substance use problems, poor psychosocial functioning, a recent history of violent behavior, higher rates of lifetime hospitalization and of involuntary hospitalization, and recent police encounters during mental health crises. Nearly three-quarters of persons who reported outpatient commitment or related civil court orders also reported experiencing other forms of leveraged treatment, and these multiple leveraged-treatment experiences were strongly associated with high perceived coercion and poor satisfaction with treatment. CONCLUSIONS: A history of civil court-ordered outpatient treatment was most common among persons with mental illness who came into contact with multiple mental health, social welfare, and criminal justice agencies, many of which applied their own forms of leveraged treatment in attempts to improve adherence. Further research is needed to guide policy makers in implementing coordinated and effective responses to treatment nonadherence.

Adult↗
PubMed1995

Who will pay for involuntary civil commitment under capitated managed care? An emerging dilemma.

Involuntary civil commitment in managed care settings may create conflicts between providers and payers. Providers may determine that a patient, particularly one who presents a risk to self or others, must be confined beyond the period reimbursed by the payer. Court decisions have upheld clinicians' ethical obligations to provide care in these situations. In addition, civil commitment may be used to shift costs of long-term care to another provider. The author explores these issues and suggests six strategies that providers can use to address them. They include avoiding negotiations with payers over individual patients' care by ensuring that contracts with payers address civil commitment and patients at risk of harming themselves or others, identifying and creating services and social supports to reduce the necessity for commitment and allowing creative use of benefits, adopting formal risk assessment protocols to standardize the process for all patients and and clinicians, conducting research on the use of civil commitment and coercion in managed care settings, ensuring that incentives do not exist in states' Medicaid managed care programs to use civil commitment to shift costs, and holding discussions with treatment staff about the growing encroachment of financial considerations into treatment decisions.

Adult↗
PubMed2003

Do Canadian civil servants care about the health of populations?

OBJECTIVES: This article describes Canadian civil servants' awareness of, attitudes toward, and self-reported use of ideas about the determinants of health. METHODS: Federal and provincial civil servants in departments of finance, labor, social services, and health were surveyed. RESULTS: With civil servants in finance departments a notable exception, most Canadian civil servants see the health of populations as a relevant outcome for their sectors. Many (65%) report that ideas about the determinants of health have already influenced policymaking in their sector, but most (83%) say they need more information about the health consequences of the policy alternatives their departments face. CONCLUSIONS: Civil servants should consider developing accountability structures for health and researchers should consider producing and transferring more policy-relevant research.

Attitude to Health↗
PubMed1988

[Importance of the initial examination after a rape in considering the criminal penalty and indemnification of the victim in a civil suit. Review of the documents from one Court of Assizes over 11 years].

The gynaecologist-obstetrician may be the medical witness who has to give evidence about the extent of the initial trauma after the presumption of a sexual assault on a victim who comes to consult him, or as an expert witness. The certificate that he gives at the time of the first consultation is an essential document for the examining magistrates who have to decide whether there has been an offence. It is also a very great help to support the brief for the lawyers in a civil action taken by the victim, who is claiming damages as compensation for physical or psychological damage resulting from the sexual abuse. The authors reported it useful to look through 64 case documents that were considered in 11 years. They studied the differences in the penalties that were awarded for criminal offences and the sums of money for indemnity that were awarded in civil cases. These were before the new law concerning rape was passed on the 23rd December 1980, and after this law had been applied. It tends to improve the position for the victim in civil cases and increases the sentences that can be passed for aggravated rape (as on a minor by an adult, or in particular somebody who has a position of responsibility to the child). The authors point out especially how important it is to take note of sexual precocity and to have a detailed account of the first investigations carried out after the sexual assault. These can be used to make the sentences differ and to make it possible to increase and widen the awards given to compensate the victims. As far as civil action is concerned, as there is usually a fixed scale for every regional Court of Assizes according to a definite formula, it is advisable according to the authors that the initial expert assessment presented by the magistrates should establish in its conclusions the details of the indemnity to be considered by professional judges of the Assize juries. They should take particular notice of added injuries that are not physical and are often not considered, such as pain and suffering, loss of pleasure and the aesthetic, the sexual, the obstetrical and the moral as well as the juvenile points of view. In certain cases ad full medical assessment presented before the end of the case will help the professional judges of the jury of Assizes who have to give judgment in a civil action by giving them information that will support the true interests of the victim.

Expert Testimony↗
PubMed2000

What is the role of procedural justice in civil commitment?

OBJECTIVE: To determine best practice management strategies in the clinical application of civil commitment. METHOD: All relevant literature on the topics of 'civil commitment', 'coercion' and 'procedural justice' were located on MEDLINE and PsychLIT databases and reviewed. Literature on the use of Ulysses contracts and advance directives in mental health treatment was integrated into the findings. RESULTS: Best practice evidence that guides management strategies is limited to the time of enactment of civil commitment. Management strategies involve enhancing the principles of procedural justice as a means of limiting negative patient perception of commitment. In the absence of evidence-based research beyond this point of enactment, grounds for the application of the principles of procedural justice are supported by reference to ethical considerations. Ulysses contracts provide an additional method for strengthening procedural justice. CONCLUSIONS: Procedural justice principles should be routinely applied throughout the processes of civil commitment in order to enhance longer term therapeutic outcomes and to blunt paternalism.

Advance Directives↗
PubMed2005

Urethral injuries in the Civil War.

PURPOSE: We compiled all cases of urethral injury received in battle during the Civil War to detail their management and determine the outcome of treatment. MATERIALS AND METHODS: Surgeon medical reports of individual cases of urethral injury listed in the Medical and Surgical History of the Civil War, and pension records available in the National Archives and Records Administration were reviewed. RESULTS: A total of 105 cases of urethral injury from gunshot wounds, comprising 7% of all urogenital casualties, were reported during the Civil War between 1861 and 1865. Of them 22 (21%) were fatal and 83 patients (79%) cases survived. Debridement and catheter drainage of urinary extravasation or perineal urethrotomy was initial treatment. The majority of urethral injuries were complicated by troublesome strictures, fistulas, urinary incontinence and erectile impotence. Only 19 patients (23%) recovered fully. CONCLUSIONS: Civil War urethral injuries had devastating long-term consequences.

American Civil War↗
PubMed1995

Adolescents' and young adults' conceptions of civil liberties: freedom of speech and religion.

This study examined adolescents' and young adults' conceptions of freedom of speech and religion (civil liberties). 48 adolescents and young adults in 3 grade levels (mean ages 12-8, 16-10, and 19-6) were administered a structured interview containing assessments of civil liberties in general, in straightforward (unconflicted) applications, and in conflict with other social and moral concerns, including law, physical and psychological harm, and equality of opportunity. Freedom of speech and religion were conceptualized as universal rights and applied to social events in unconflicted contexts at all ages. A diverse array of rationales, differentiated according to type of freedom, were used at all ages to ground conceptions of universal freedoms. Judgments of civil liberties in conflicts exhibited several sources of variation, including developmental differences, situational or contextual variation determined by the particular types of issues in conflict, and individual differences. Results are consistent with the proposition that judgments of civil liberties reflect age-related patterns of coordination of delimited social and moral concepts rather than general orientations.

Adolescent↗
PubMed1990

A comparison of civil patients and incompetent defendants: pre and post deinstitutionalization.

There has been a great deal of speculation that deinstitutionalization has resulted in the criminalization of the mentally ill. Using two samples of defendants found incompetent to stand trial (IST) and two samples of civil patients randomly selected from five states, pre and post deinstitutionalization, this research compares changes in their mental health and arrest histories. After deinstitutionalization, fewer and less dramatic differences in the arrest and mental health histories were evident between ISTs and civil patients. Both patient samples displayed significant increases in prior hospitalization and arrest histories. Among the civil patients there was a significant increase in the frequency and seriousness of criminal activity. There was no evidence that IST commitments are being expanded to hospitalize the nondangerous mentally ill no longer subject to civil commitment.

Civil Rights↗
PubMed1995

A pay-for-performance system for civil service doctors: the Indonesian experiment.

In 1980 the Government of Indonesia proposed the introduction of a pay-for-performance system, the Functional Position System (FPS), for certain occupational categories of civil servants to provide a career development path and stimulate productivity (Government of Indonesia. Government Ordinance No. 3, 1980 Concerning Appointment to Civil Service Rank. Jakarta, 1980). The FPS, a bold pay concept in the civil service, links pay to skills and performance. In 1987, instructions were issued for doctors to be included in the system (Government of Indonesia, Credit Scores for Doctors. Circular Issued by the Ministry of Health and the Agency for Administration of the Civil Service No. 614/MENKES/E/VIII/1987 and No. 16/SE/1987). In this paper we evaluate how well the system-which in principle could be applicable to both developed and developing economies--can meet its stated objectives for Indonesian doctors working in the community, and for Indonesian health policy objectives as stated in the country's last five-year development plan "Repelita V" (Government of Indonesia. The Fifth Five-year Development Plan (Repelita V) 1989-1994. Jakarta, Indonesia, 1989). The FPS is particularly innovative in the Indonesian environment where wages are low and comparatively uniform, reflecting a philosophy of 'shared poverty', and vary primarily by seniority. The FPS has, however, several conceptual and practical shortcomings. The design of the reward system disregards effort or time inputs, as well as other inputs needed per unit of reward. Consequently, the FPS can not be used as an effective incentive system promoting professional excellence and health policy objectives. Practically, the system hardly provides an effective alternative for career development among community physicians.(ABSTRACT TRUNCATED AT 250 WORDS)

Career Mobility↗
PubMed2003

From hand maiden to right hand--the Civil War.

Before the onset of the US Civil War, women were expected to take care of individuals in their households who were sick or injured. The Civil War marked the first time the concept of women working as nurses outside of the household was established in the United States. This article, which is the first in a two-part series on nursing during the Civil War, outlines the medical conditions in the United States at the start of the War Between the States. The second article in this series will detail the role of the first female Civil War nurses.

Female↗
PubMedDate not supplied

Panel 2.15: civil-military cooperation in humanitarian health action.

This is a summary of the presentations and discussion of Panel 2.15, Civil-Military Cooperation in Humanitarian Health Action of the Conference, Health Aspects of the Tsunami Disaster in Asia, convened by the World Health Organization (WHO) in Phuket, Thailand, 04-06 May 2005. The topics discussed included issues related to civil-military collaboration in humanitarian health actions as pertain to the responses to the damage created by the Tsunami. It is presented in the following sections: (1) how effective civil-military cooperation can help health responses, including: (a) needs assessment; (b) coordination; (c) filling gaps; and (d) capacity building; (2) what was done well, and what could have been done better; and (3) conclusions and recommendations. Conclusions and recommendations included: (1) the best coordination mechanisms for civil-military cooperation; and (2) suggested additions and improvements.

Altruism↗
PubMed2004

The criminogenic, clinical, and social problems of forensic and civil psychiatric patients.

Forensic psychiatric patients consume an increasing proportion of mental health resources in Canada and the United States. To inform mental health policy and practice, we compared the criminogenic, clinical, and social problems of forensic patients to those of civilly committed psychiatric patients in two Canadian studies. We predicted that forensic patients would score higher on criminogenic problems and lower on clinical and social problems than civil patients in two studies: one comparing 83 forensic and 189 civil inpatients on a clinician-completed form, the Resident Assessment Instrument--Mental Health, at an urban mental health center, and the second comparing 423 forensic and 178 civil patients assessed at different times using the Patient Problem Survey. The two studies were quite similar in their findings, despite differences in their samples, measures, and data collection methods. In both studies, forensic patients were similar to or lower than civil psychiatric patients in all criminogenic, clinical, and social problems. We conclude that forensic mental health services would benefit greatly by drawing from knowledge accumulated in the general psychiatric literature. This finding also supports the idea that many forensic patients can be appropriately diverted to nonforensic mental health services.

Adult↗
PubMed2001

The reliability of perinatal and neonatal mortality rates: differential under-reporting in linked professional registers vs. Dutch civil registers.

Official Dutch perinatal mortality rates are based on birth and death certificates. These civil registration data are not detailed enough for international comparisons or extensive epidemiological research. In this study, we linked and extrapolated three national, incomplete, professional registers from midwives, obstetricians and paediatricians, containing detailed perinatal information. This linkage and extrapolation resulted in one detailed professional database which is representative of all Dutch births and from which gestational age-specific perinatal mortality rates could be calculated. The reliability of these calculated mortality rates was established by comparing them with the rates derived from the national civil registers. The professional database reported more perinatal deaths and fewer late neonatal deaths than the civil registers. The under-reporting in the civil registers amounted to 1.2 fewer perinatal deaths per 1000 births and was most apparent in immature newborns. We concluded that under-reporting of perinatal and neonatal deaths depends on the data source used. Mortality rates for the purpose of national and international comparison should, therefore, be defined with caution. This study also demonstrated that combining different incomplete professional registers can result in a more reliable database containing detailed perinatal information. Such databases can be used as the basis for extensive perinatal epidemiological research.

Data Collection↗
PubMed2000

Pharmacy in the American Civil War.

The role of pharmacists and the process of military drug supply in the American Civil War are described. Most raw drugs used in the United States in the mid-1800s were imported. During the Civil War, imports into the North continued, but the Union blockade forced the Confederacy to obtain medicines through means such as smuggling, capture of enemy supplies, and processing of indigenous medicinal plants. Medical supplies for Civil War troops were typically purchased by military physicians called medical purveyors and sometimes by pharmacists serving as acting medical purveyors. In the latter half of the war, U.S. Army medical laboratories, in which many pharmacists were employed, inspected purchases, repackaged supplies bought in bulk, and manufactured medicines from raw materials. The Confederacy also had medical laboratories, which were primarily responsible for manufacturing medicines from indigenous plant material but also inspected drugs that had been smuggled into the South. At a few large Union medical depots, pharmacists called medical storekeepers assumed many of the responsibilities of medical purveyors by receiving, storing, issuing, and accounting for supplies. Noncommissioned officers called hospital stewards assumed diverse duties that included dispensing drugs prescribed by military physicians. Although many hospital stewards were pharmacists or physicians, others had no previous pharmaceutical experience. Civilian pharmacists were employed in the medical laboratories and in military general hospitals. Pharmacists participated in nearly every aspect of military drug supply during the Civil War.

History, 19th Century↗
PubMed2004

Civil law problems and morbidity.

STUDY OBJECTIVE: In the United Kingdom, recognition of the links between social and health problems has led to government initiatives such as health action zones. The principles of civil law apply to many types of social problem, and the civil justice system provides one means through which they can be tackled. However, little research has been undertaken into the particular links between problems to which civil legal principles and processes can be applied and morbidity. This study examines these links, and the role of legal advice and services in preventing ill health. DESIGN: This study examined survey respondents' self reports of longstanding illness/disability and experience of 18 problems to which legal principles can be applied. SETTING: A random national survey conducted across England and Wales. PARTICIPANTS: 5611 adults drawn from 3348 residential households. MAIN RESULTS: Significant associations were found between illness/disability and 13 of the problem types. Moreover, experience of greater numbers of problems increased the likelihood of reported illness/disability. In attempting to resolve problems respondents' health also frequently suffered. CONCLUSIONS: This study highlights the contribution that public legal education and legal advice can make to the promotion of public health, and the importance of further integration of health and civil justice initiatives through health action zones, community legal service partnerships, etc, to further this end.

Adult↗
PubMed1982

Short-term civil commitment and the violent patient.

To explore the specificity of criteria for civil commitment for dangerousness, the authors examined the relationship between civil commitment for dangerousness to others under the California Civil Commitment Statute (the Lanterman-Petris-Short Act) and violent acts and behavioral ratings made immediately after commitment. Using a prospective design they evaluated 84 subjects. The ratings of violent acts for subjects considered dangerous to others were no different than those of a nondangerous control group. The subjects considered dangerous to others, however, differed on several subscales of the Brief Psychiatric Rating Scale. The authors discuss the implications of these results for civil commitment proceedings.

Adult↗
PubMed1994

Oregon's civil commitment law: 140 years of change.

Legislatures, professional groups, and mental health consumers across the United States are currently engaged in a debate about the need for change in civil commitment procedures. The authors summarize modifications of legislation and judicial opinion in the history of Oregon's civil commitment procedures from 1853 to the present to show that changes in civil commitment reflect broader shifts in the social and political aspects of the mental health system. Many current issues in civil commitment, such as the question of a patient's competency to make treatment decisions, are not new, and they are likely to continue to be controversial as mental health systems attempt to balance concerns about the liberty interests of mentally ill persons with concerns about providing appropriate treatment for mental illness.

Advance Directives↗