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PubMed1989

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↗
PubMed1989

Chronic mental illness and the criminal justice system.

A total of 260 family members responded to a survey seeking information about their mentally ill relatives' contacts with the criminal justice system. Reports by family members indicated that the mentally ill relatives were mainly men in their early thirties with a diagnosis of schizophrenia or bipolar disorder; they had had an average of four admissions to a state mental hospital. The majority had been arrested, but only a fifth had been convicted of a crime. Substance abuse and noncompliance with psychiatric medications were significant predictors of arrest. Family members overwhelmingly attributed the arrests to psychiatric crises, and in about half the cases a failed attempt at commitment had preceded the arrest. However, only a minority of the mentally ill relatives were taken to a hospital at the time of the arrest. The findings highlight the need for closer collaboration between mental health specialists and law enforcement personnel.

Adolescent↗
PubMed1989

HIV and the mentally ill: an approach to the legal issues.

The epidemic of human immunodeficiency virus (HIV) requires mental health clinicians to make many decisions that present legal dilemmas, yet few clear rules of law exist that address HIV antibody testing, confidentiality of information about patients' HIV status, clinicians' duty to protect third parties, and discrimination against HIV-infected individuals in psychiatric settings. The author recommends a balance between the legal interests of infected and uninfected persons in addressing these issues. HIV antibody testing or disclosure of information about an individual's HIV status without informed consent should be strictly limited and done only when clinically necessary. Nondiscriminatory treatment for HIV-infected patients and protection of uninfected persons is best approached by use of universal infection control procedures and individualized clinical judgment.

AIDS Serodiagnosis↗
PubMed1990

Hospitalized pregnant psychotic women: characteristics and treatment issues.

The medical records of 35 pregnant women hospitalized for nonorganic, psychotic symptoms were reviewed to determine their demographic and psychosocial characteristics as well as patterns of assessment, treatment, and disposition. The review showed that the majority of the women had been hospitalized five times or more and lacked social and economic supports. Almost two-thirds had had two or more pregnancies, but only two were living with their children. The review also showed that the basic issues of birth control methods and infant custody rights were not addressed by the hospital treatment program. The authors urge that discussions of birth control methods be included in the treatment plans of pregnant psychotic patients and that recommendations regarding infant custody be recorded in the patients' charts.

Adolescent↗
PubMed1990

Family members' opinions about civil commitment.

As part of a survey of 260 Oregon family members with mentally ill relatives, respondents were asked about their experiences with civil commitment and their opinions about proposed modifications in the commitment statutes. Family members typically described their mentally ill relative as a schizophrenic man in his thirties who had had six psychiatric hospitalizations and was currently being treated with medications at a community mental health center. Three-fourths of the relatives had been committed. A majority (57 percent) of the respondents were in favor of mandatory outpatient treatment and medication after involuntary hospitalization but were not enthusiastic about outpatient commitment without hospitalization. Family members also wanted more education about mental illness, more information about the commitment process, and assignment of a professional to help in the commitment process.

Bipolar Disorder↗
PubMed1990

Clinical guidelines for the use of involuntary outpatient treatment.

Successful involuntary psychiatric outpatient treatment requires identifying patients who are suited to such treatment and ensuring that the service system is able to deliver the treatment. Based on his clinical experience, the author has developed ten sequential guidelines that can help clinicians identify patients who are appropriate for involuntary outpatient treatment. The sequential order of the guidelines means that a patient must meet the criteria for each guideline before being evaluated on subsequent guidelines. The guidelines assume that the patient has a chronic mental illness and a history of dangerousness to self or other because of that illness. The author believes that achieving consensus about who should receive involuntary outpatient treatment is an important first step in permitting evaluation of the efficacy of the approach.

Adult↗
PubMed1990

Monitoring insanity acquittees: Connecticut's psychiatric security review board.

In 1985 Connecticut established an administrative psychiatric security review board to monitor the postverdict disposition of defendants found not guilty by reason of mental disease or defect. The five-member board may confine an insanity acquittee in a mental hospital, grant temporary leave, order conditional release, and terminate confinement or conditional release. Judicial review is required before a patient is discharged from the board's custody. Between 1985 and 1989, a total of 173 insanity acquittees were under the board's jurisdiction; most were hospitalized in state psychiatric facilities. The authors discuss issues that must be addressed in creating a psychiatric security review board, including the conflict between protecting the public and treating insanity acquittees, clinicians' resistance to treating these patients, and problems posed by patients who do not appear to be mentally ill or who are well known to the public.

Adolescent↗
PubMed1991

A model hospital policy on prosecuting patients for presumptively criminal acts.

Evidence suggests that violence by psychiatric inpatients, especially in public-sector hospitals, may be on the rise. The authors present a model policy developed at a state hospital for deciding whether to prosecute presumptively criminal assaults by patients. The policy addresses the circumstances under which it is ethically permissible to file a criminal complaint while emphasizing the need to use clinical interventions first and to consider the clinical sequelae of prosecution. The authors also review criticisms made of the policy, which reflect opposing views that prosecution is unjustified and that the policy unduly restricts the use of prosecution. In the first six months after the policy became effective, state hospital staff considered filing charges against five patients, but no case progressed beyond the first steps in the implementation procedure.

Confidentiality↗