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PubMed2006

Law & psychiatry: "depressed? Get out!": dealing with suicidal students on college campuses.

This column examines college and university policies under which students who manifest suicidal ideation are barred from campus, usually by immediate suspension or mandatory withdrawal. Such policies, which appear to be increasing on U.S. campuses, generally reflect administrators' fears of legal liability if students commit suicide on campus. The author reviews two recent cases-Schieszler v. Ferrum College and Shin v. Massachusetts Institute of Technology-that have created a climate of fear among administrators and suggests ways to change blanket policies so that students at low risk of suicide will not be barred from campus and will seek and obtain appropriate treatment.

Adolescent↗
PubMed1977

Criminal justice procedures in civil commitment.

The actions of federal district courts and state legislatures in recent years have resulted in the growing application of procedures of the criminal justice system to the civil commitment process. Increasingly patients can be confined only if they are dangerous to others, and increasingly due-process procedures of the criminal law are required, to the detriment of the patient's treatment and his survival in the community. The author says that allegations of patients' being railroaded into hospitals are, with few exceptions, fictitious. Abuses thet do exist should be handled through writs of habeas corpus and malpractice suits, remedies much more available now than in the past. The principal abuse in commitment occurs not when patients are admitted, the author believes, but at discharge, when so many patients are turned out into communities that lack proper services for them.

Child Advocacy↗
PubMed1977

Implications of the Donaldson decision: a model for periodic review of committed patients.

In 1976 the Connecticut Valley Hospital, the Yale University School of Law, and the department of psychiatry of the Yale School of Medicine, undertook a project in which all involuntary patients at the hospital, a total of 107, were reviewed by three interdisciplinary panels, each composed of a law student, a psychiatric resident, and a hospital social worker. The major purposes of the project were to identify those patients entitled to release under the Donaldson criteria, to develop a model review procedure, and to assess the need for alternative placements. The panels found no patients resembling Kenneth Donaldson, but they did find 53 per cent of the patients inappropriately detained on involuntary status. However, in most cases the recommendation was transfer to a nursing home because of the patient's high degree of disability. The authors emphaxize the importance of periodic external reviews of commitment status.

Activities of Daily Living↗
PubMed1977

A study of involuntary patients in Seattle.

The authors describe a study of 224 involuntary patients admitted to, Harborview Medical Center in Seattle in 1974, the first year of the implementation of Washington States Involuntary Treatment Act. The patients, 115 men and 109 women, had a total of 297 episodes of hospitalization, with an average length of stay of 12.7 days. Fifty-one per cent were discharged in less than ten days. The authors compare the findings with studies of similar patient groups in Sacramento, California, and New York City. They concur with others who believe involuntary treatment statues provide a means of dealing with the small group of psychiatric patients whose needs would otherwise go unattended.

Adolescent↗
PubMed1977

A review of criminally insane patients in Ohio: a personal narrative.

In 1974, acting on precedents set in other cases, a federal district court in Ohio ordered the re-evaluation of all patients committed to Lima State Hospital to determine the need for their continuing to be held in a maximum-security facility. The court set a 12 week period for the review of more than 600 patients by three-member teams consisting of a psychiatrist, a psychologist, and a social worker. The author, a psychoanalyst, was one of approximately 30 professionals who volunteered to participate in the project, which was completed three weeks ahead of schedule. He describes the review process and his personal reactions and observations as a participant.

Commitment of Persons with Psychiatric Disorders↗
PubMed1978

A review board for determining the dangerousness of mentally ill offenders.

Partly as the result of legislative changes made in 1975 and 1977, Texas has a workable system for dealing with mentally abnormal offenders and assessing the dangerousness of committed offenders. The author summarizes provisions of the law related to pretrial evaluation, competency to stand trial, dispositions after a ruling of incompetency, and the insanity defense. He describes the activities, during the first two years, of multidisciplinary review boards for manifest dangerousness; the boards met monthly to assess the dangerousness of patients committed to a state hospital's maximum-security unit after rulings of incompetency (without the probability of attaining competency in a foreseeable period) or of not guilty by reason of insanity. During the two years, the boards declared 171 of 364 patients to be not manifestly dangerous and thus ready for transfer or release, but they became more conservative in making judgments of not dangerous as time passed.

Adult↗
PubMed1979

The use of seclusion on an inpatient crisis intervention unit.

Because of the use of seclusion is controversial, a retrospective study of 50 patients was designed to examine how seclusion is actually being used on a short-term inpatient crisis intervention unit. It was found that 44 per cent of the patients were secluded during their stay. Neither sex nor race seemed to be a factor in whether a patient was secluded, but elderly patients and depressed patients were less likely to be secluded. Most of the seclusions occurred on the first day of hospitalization, with the four most common reasons being agitation, uncooperativeness, anger, and history of violence. The author speculates that the use of seclusion on the crisis unit is related to the characteristics of the patient population as well as to the short duration of patient stay.

Adult↗
PubMed1979

From the hospital to the prison: a step forward in deinstitutionalization?

In Massachusetts there is a growing trend to transfer both direct and indirect mental health service delivery from civil mental hospitals to prison facilities. Three factors associated with deinstitutionalization and a community-based delivery system appear to have contributed to the trend. Those factors are the over-all compromising of programming caused by unitization of state hospitals and the requirement that a full range of psychiatric services be available in every community, the decrease in morale and training of state hospital employees not involved in community treatment, and the lack of outreach to patients in the community who are dangerous or difficult to deal with.

Adult↗
PubMed1980

Mental health commitment: the state of the debate, 1980.

This overview of recent mental health commitment litigation and statutes begins with the 1972 decision by a federal district court in Wisconsin that the state's procedures for commitment were constitutionally defective; the case, Lessard v. Schmidt, was a bellwether for the decade. By 1979 three major mental health cases concerning civil commitment reached and were decided by the U.S. Supreme Court--O'Connor v. Donaldson, Addington v. Texas, and Parbam v. J. R. The author reviews the impact of changing standards and procedures on commitment and discusses in some detail the Addington and Parbam cases. He feels that one lesson of those cases is that the positions of the main disputants in the commitment controversy--legal advocates and beleaguered professional--must be compromised. He also discusses the logical culmination of the continuing controversy between law and psychiatry about civil commitment: the committed patient's right to refuse customary treatment.

Commitment of Persons with Psychiatric Disorders↗
PubMed1981

Law & Psychiatry.

Explore the source record for details and available documents.

California↗
PubMed1982

Beyond deinstitutionalization: a commitment law in evolution.

In 1973 Washington State changed its civil commitment law to more rigorously control the number of involuntary commitments in a move consistent with the national trend toward deinstitutionalization of the mentally ill and the development of community treatment alternatives. In 1979, after six years of working within narrowly drawn criteria for commitment, the state strengthened its civil commitment authority through revisions that included expanding the definition of "gravely disabled", adding destruction of property to the "likelihood of serious harm" clause, making the provisions for revoking conditional releases more stringent, and allowing spouses of mentally ill individuals to testify against them during commitment proceedings. Early figures show that involuntary commitments, while trying to cope with federal cutbacks and diminishing resources.

Commitment of Persons with Psychiatric Disorders↗
PubMed1982

Supreme Court decisions on mental health: a review.

Since the late 1960s mental health advocates have filed numerous lawsuits against mental health institutions in an effort to narrow the standards for civil commitment, improve the care of patients, and define patients' rights. While many of the lawsuits were successful in attaining these goals at the district and appellate court levels, review by the Supreme Court generally has resulted in decisions blunting the lower court rulings. The high court has rejected broadly worded lower court decisions on commitment laws, standards of proof in commitment hearings, and patients' rights. The court also has upheld the traditional reliance on decision-making by medical professionals. The author describes a number of these cases and their decisions and concludes that cases now before the Supreme Court very likely will result in decisions that strike a balance between the needs of the patients and those of treatment staff.

Adult↗
PubMed1982

The insanity defense on trial.

What was once a great romance between law and psychiatry has ended in disenchantment on both sides. Legal rulings during the 1950s intended to increase the psychiatric presence in the courtroom have been repudiated, and there is now a mood to abolish the traditional insanity defense. Abolitionists charge that the insanity defense has been successfully employed by large numbers of dangerous criminals to avoid punishment, that psychiatrists are dishonest because they serve as expert witnesses for both sides, and that the existence of the defense is evidence of a permissive society that coddles violent criminals. Each of these charges is rebutted by the author, who contends that until recently the insanity defense was a profound hypocrisy: the courts found the defendants not guilty by reason of insanity and then relied on psychiatry to confine them for the rest of their lives. But legal reforms and changes in psychiatric practice during the past 20 years have made it more difficult to confine such persons, and thus the insanity defense has real meaning for the first time. The author believes that despite the loss of protection to society, there are important legal and moral barriers to abolishing the insanity defense.

Commitment of Persons with Psychiatric Disorders↗