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PubMed1978

Psychiatrists' familiarity with legal statutes governing emergency involuntary hospitalization.

The authors sent out questionnaires regarding knowledge of statutes governing emergency involuntary hospitalization to psychiatrists in Connecticut and in the District of Columbia. Fifty-five percent (N=207) of the sample in Connecticut and 25% (N=87) of the sample in the District of Columbia responded. The responses showed that few of these psychiatrists had a thorough familiarity with the legal statutes governing emergency involuntary hospitalization in their jurisdictions. The most frequently cited criterion was the dangerousness standard, especially in the District of Columbia sample, and many psychiatrists were not sure of the nature of their statutory authority when their patients met the criteria for emergency hospitalization.

Commitment of Persons with Psychiatric Disorders↗
PubMed1979

Violence associated with phencyclidine abuse.

Violence associated with chronic phencyclidine (PCP) abuse was investigated by administering a structured interview to 16 chronic PCP abusers. A more intensive study was done of another individual who committed murder and self-mutilation under the influence of PCP. The results suggest that there is no consistent association between PCP-related violence and a history of violence not related to drug or alcohol abuse. The author defines four types of violence associated with chronic PCP abuse.

Adult↗
PubMed1979

A commitment law for patients, doctors, and lawyers.

The author proposes a model commitment law that balances the sometimes conflicting points of view among patients, doctors, and lawyers about this subject. Paternalism is affirmed, while safeguards are provided. It is argued that absent patient incompetency to consent to or refuse treatment, or absent an emergency, mental patients should not be treated involuntarily. The author believes that a different procedural approach is required depending on whether the patient is committed under the parens patriae or police power of the state.

Commitment of Persons with Psychiatric Disorders↗
PubMed1980

Psychiatric emergencies: an overview.

The psychiatric emergency ward has become a primary entry point into the network of mental health services for people who need help to cope with their problems of living. It is also the only source of treatment for many chronically mentally ill patients living in the community. The authors critically review the literature on emergency psychiatric services, focusing on the ways these services are used, the atmosphere in the emergency room, and the determinants of disposition decision making. On the basis of their research, they suggest a model for emergency services that includes an evaluation of the patient's and his on her community's resources and competence and minimizes subtle diagnostic considerations.

Age Factors↗
PubMed1980

Insanity acquittals in New York State, 1965--1978.

The author presents data on the use of the insanity defense to provide a basis for current debates on its revision. Generally, the experience in New York State in 1976--1978 reflects an increasing number of insanity acquittals over 1965--1976, but the characteristics and length of hospitalization of the defendants remained fairly similar. In addition, in some counties the defense was used often, but in others it was not used at all. The author suggests that similar, more sophisticated analyses of the actual operation of the insanity defense be carried out to establish an adequate basis for designing rational social policy.

Adult↗
PubMed1980

The psychiatrist's double bind: the right to refuse medication.

The assertion of a patient's right to refuse medication places a psychiatrist in a double bind because he or she knows that medication will often greatly relieve mental disturbance. Delaying medication until the patient is formally judged incompetent and a guardian appointed causes discomfort for the patient, the physician, staff, and other patients. On the other hand, forcing medication on a patient undermines the latter's sense of autonomy and may interfere with his or her constitutional rights, as a federal judge has ruled in the famous Boston State Hospital case. The right to refuse medication presents a uniquely intriguing case study of a need for accommodation between abstract constitutional concepts and practical realities and has opened a profound legal and ethical debate about the nature of "true freedom."

Commitment of Persons with Psychiatric Disorders↗
PubMed1980

Drug refusal: a study of psychiatric inpatients.

The authors studied patients' refusal of medication during a three-month period on an inpatient service of a community mental health center. Although refusal of medication was common, most episodes were self-limited. Only 5 of 72 episodes seriously impaired patient care; each of these cases appeared to be delusionally motivated. Legal conceptions of a right to refuse treatment may not accurately portray the realities of the clinical situation, in which patients' refusal is determined by the dynamics of their illness rather than reflecting a principled exercise of their legal rights.

Adolescent↗
PubMed1980

Psychiatric and nonmedical decisions on commitment.

The civil commitment statutes of Oregon were changed in 1973 and 1975 to include nonphysician court examiners and public prosecutors in the commitment hearing. To evaluate the effect of these changes the authors compared the commitment decisions actually made by panels composed of two physicians with those made by panels with one physician and one nonphysician mental health professional. They also compared the commitment decisions made by six groups of medical and nonmedical people involved with the commitment process regarding five case vignettes. They found that decisions made by the nonmedical mental health professionals were not significantly different from those made by the psychiatric examiners.

Adult↗
PubMed1980

Perceived statutory applicability versus clinical desirability of emergency involuntary hospitalization.

The authors used a questionnaire survey conducted by mail in 1975 to assess psychiatrists' perceptions of the applicability of two jurisdictions' statutes for emergency involuntary hospitalization and the desirability of such hospitalization in four case vignettes. The great majority of the 287 respondents agreed that the statutes were applicable and hospitalization was desirable for individuals who were at risk for suicide and who were psychotic. Most of them also agreed that such hospitalization was neither legally applicable nor desirable for nonpsychotic, nonsuicidal people. Their perceptions of applicability versus desirability differed, however, regarding people who were nonsuicidal but psychotic or nonpsychotic but suicidal.

Attitude of Health Personnel↗
PubMed1982

The psychiatrist-witness and legal guilt.

Psychiatrist-witnesses testifying in criminal cases are usually asked if the defendant's mental state at the time of the offense met the legal standards for mitigation or exculpation. These standards use a commonsense frame of reference resting on assumptions of free will and self-control, which may differ from the framework clinical psychiatrists usually employ in their work. An understanding of the process of "transduction" between different systems may help resolve problems created by these different frames of reference.

Dangerous Behavior↗