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PubMed1984

Psychiatrists' judgments of dangerousness in patients on an acute care unit.

Statistical analyses suggest that psychiatrists emphasize hostility, agitation, previous assaultiveness, and suspiciousness as factors predictive of violence in psychiatric inpatients. When the actual correlates of violence in these patients are evaluated, a different picture of the assaultive inpatient emerges. Examination of differences between the cues emphasized by clinicians to make their predictions and the empirical correlates of violence suggests ways of improving the accuracy of clinical judgments of inpatients' dangerousness.

Attitude of Health Personnel↗
PubMed1984

The paradoxical impact of a commitment statute on prediction of dangerousness.

Forty psychiatrists in Arizona were asked to rate the dangerousness to self or others of 16 patients described in case histories and to recommend an appropriate course of action. Half the psychiatrists were given the state defining dangerousness to use in responding. Psychiatrists who used the statute summary were less consistent in their predictions of dangerousness than were those who did not use it, especially when the patient had a history of violence. The concept of cognitive dissonance is used to partially explain this paradoxical finding.

Arizona↗
PubMed1984

Forensic psychiatry and applied clinical ethics: theory and practice.

The authors briefly describe and then apply a new method--applied clinical ethics--for identifying and working with ethical problems. This method, starting from the clinical context, develops ethical constructs that may be tested in clinical practice and revised if required. The work was done in the context of a combined university-county forensic psychiatric service. The authors discuss three of the identified ethical issues: effects of deinstitutionalization, countertransference with forensic populations, and prediction of dangerousness. They discuss the basis for developing ethical norms from clinical experience and suggest ethical guidelines for medical practice.

Adolescent↗
PubMed1985

White House Cases: psychiatric patients and the Secret Service.

Delusional visitors to the White House or other government offices (often seeking a personal audience with the President) are interviewed by the Secret Service and then sent to Saint Elizabeths Hospital if they are considered mentally ill and potentially dangerous to themselves or others. A review of the demographic characteristics and diagnoses of 328 of these "White House Cases" treated at the hospital between 1970 and mid-1974 showed that these patients were most commonly unmarried, white, and male, and most had a diagnosis of paranoid schizophrenia. Although 22% of this group have threatened some prominent political figure, to date none of this study's patients has attempted to assassinate any such government official.

Adult↗
PubMed1985

Tarasoff and the clinician: problems in fulfilling the duty to protect.

The obligation to protect potential victims of one's patients, as first described in the California Tarasoff case, is being endorsed by an increasing number of jurisdictions. Although problematic in many respects, it has become a factor that must be dealt with in routine clinical interactions. The author presents a three-part model of the Tarasoff obligation--identifying the requirements of assessment, selection of a course of action, and implementation--and illustrates with case examples the mistakes that clinicians commonly make at each of these stages. Guidelines are suggested for a reasonable approach to dealing with the Tarasoff doctrine.

Adolescent↗
PubMed1985

The criminality of the mentally ill: a dangerous misconception.

A longstanding controversy is the relative dangerousness and criminality of the mentally ill. The author presents observational data from 1,072 police-citizen encounters in an urban area. The data show that persons exhibiting signs of serious mental disorder were not suspected of serious crimes at a rate disproportionate to their numbers in the population. The patterns of crime for mentally disordered persons and for non-mentally-disordered persons were substantially similar. These data help dispel the myth that the mentally ill constitute a dangerous group prone to violent crime.

Crime↗
PubMed1986

Process analysis of judges' commitment decisions: a preliminary empirical study.

The current debate over the "police powers" versus parens patriae rationales for involuntary hospitalization of the mentally ill underscores the need for empirical study of the process of judicial decision making in civil commitment and determinations of competence. The authors report the ratings on 26 descriptive variables made by five Massachusetts district court judges for 35 patients in civil commitment hearings. Nearly all of the hearings resulted in commitments. These findings suggest that psychiatrists may be setting too high a threshold for petitioning for commitment. Experienced judges appeared to be sensitive to the kinds of clinical issues that earlier studies have shown to contribute significantly to the psychiatrist's decision to petition for commitment.

Attitude↗
PubMed1986

Vermont adopts Tarasoff: a real barn-burner.

A recent Vermont Supreme Court decision adopts and extends the Tarasoff precedent. This paper emphasizes three aspects of the new precedent that are of possible consequence to providers of mental health care. First, the decision imposes the Tarasoff duty on all "mental health professionals". Second, it demonstrates a legal scenario that in effect permits a single standard of care to be applied to all mental health professionals. Third, it creates liability for property damage as well as for personal injury.

Adult↗
PubMed1987

Predictive validity of judgments of dangerousness in emergency civil commitment.

The authors investigated the predictive validity of judgments of dangerousness made in the context of emergency civil commitment. The medical charts of 101 consecutive patients involuntarily admitted to a university-based acute inpatient unit were reviewed for evidence of violence within the first 72 hours of hospitalization. More than two-thirds of the patients committed as a danger to others engaged in some type of violence, compared with fewer than one-third of other involuntary patients. The findings suggest that the emergency commitment situation permits judgments of dangerousness with a relatively high degree of short-term predictive validity.

Adult↗
PubMed1987

The legal basis of forensic psychiatry: statutorily mandated psychiatric diagnoses.

Using the Oregon statutory scheme as an example, the authors review certain areas of the law where psychiatric expertise is mandated by statute. This review points out the diversity of determinations where forensic psychiatric expertise is required by law. The authors' thesis is that forensic psychiatry draws its vitality from the law. Legal requirements, however, should not dictate psychiatric response, which should be guided by psychiatric knowledge and ethical concerns.

Capital Punishment↗
PubMed1988

Physical assaults in a psychiatric unit of a general hospital.

The authors collected data concerning assaults, assaultive patients, and victims in a psychiatric unit during a 12-month period and compared them with data from a control group of patients. Thirty-seven assaults by 25 patients were recorded. Fourteen of the victims were patients and 23 were members of staff. The assaultive group contained a significantly higher proportion of schizophrenic patients than did the control group and significantly larger numbers of patients from lower socioeconomic classes, patients admitted involuntarily under a section of the Mental Health Act, and patients with a history of assaults.

Adult↗